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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Siregar DRG, Kawilarang AP, Kusumaningrum D, Purwanta M. A rare case report of liver masses caused by Actinomyces species. Indian J Med Microbiol 2024; 49:100573. [PMID: 38556249 DOI: 10.1016/j.ijmmb.2024.100573] [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] [Received: 06/24/2023] [Revised: 01/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Actinomycosis is a rare infection caused by Actinomyces spp. Of all actinomycosis infections, only 5% of Hepatic Actinomycosis (HA) infection has been reported. This disease is often misdiagnosed as a malignancy. This case report presents a 45-year-old woman with diabetes, initially suspected of intrahepatic cholangiocarcinoma, but after careful tissue staining, we found the results supported HA infection.
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Affiliation(s)
| | - Arthur Pohan Kawilarang
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Deby Kusumaningrum
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia; Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Marijam Purwanta
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia.
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Michael N, Parascandola S, Saint-Laurent S, Brown C, Maddox J, Bradley M, Learn P, Gage M. Rare Hypermucoviscous Klebsiella pneumoniae Liver Abscess in an Active Duty Male Requiring Partial Liver Resection for Definitive Treatment. Mil Med 2023; 188:e3720-e3725. [PMID: 37099739 DOI: 10.1093/milmed/usad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Antibiotics and drainage have largely replaced hepatic resection for the treatment of liver abscesses in the modern era; however, in cases caused by a rare strain of Klebsiella pneumoniae with a hypermucoviscous phenotype, more aggressive hepatic resection may be required. The patient is a 34-year-old male who presented to Landstuhl Regional Medical Center with a week of epigastric pain. His workup revealed a 6 cm liver abscess with growth to 10 cm in 48 hours. He underwent multiple drainage procedures at Landstuhl and then was transferred to Walter Reed where further surgical drainage was performed. Initial cultures demonstrated K. pneumoniae. He clinically improved and was able to discharge after a 2 week hospitalization. His final remaining surgical drain was removed as an outpatient, but 48 hours after removal, he was admitted to the intensive care unit in septic shock. Imaging revealed a 12 cm liver abscess, and cultures verified hypermucoviscous Klebsiella. After multidisciplinary discussion and counseling, he underwent an open right partial hepatectomy. Postoperatively he gradually recovered from his sepsis and major operation and then returned to his home in Landstuhl. This is a case of a rare hypermucoviscous variant of K. pneumoniae causing a liver abscess resistant to multiple drainage procedures, ultimately requiring open hepatic surgical resection for source control. This remains a last-resort option in the treatment of liver abscesses and should be considered early when caused by this rare strain of Klebsiella.
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Affiliation(s)
- Nicholas Michael
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Salvatore Parascandola
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Stephanie Saint-Laurent
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Colin Brown
- Landstuhl Regional Medical Center, Landstuhl/Kirchberg, Rhineland-Pfalz 66849, Germany
| | - John Maddox
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matthew Bradley
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Peter Learn
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Michele Gage
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Liu AC, Tai WC, Chiu SM, Sou FM, Yang SC, Lu LS, Kuo CM, Chiu YC, Chuah SK, Liang CM, Wu CK. The Clinical Presentations of Liver Abscess Development After Endoscopic Retrograde Cholangiopancreatography with Choledocholithiasis: A 17-Year Follow-Up. Infect Drug Resist 2023; 16:6167-6174. [PMID: 37724089 PMCID: PMC10505383 DOI: 10.2147/idr.s428125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
Background Endoscopic Retrograde Cholangiopancreatography (ERCP), used for choledocholithiasis treatment, carries a risk of pyogenic liver abscess (PLA) due to communication between the biliary system and bowel contents. However, limited data exists on this issue. This study aims to identify the risk factors pertaining to liver abscesses following ERCP lithotomy. Methods We conducted a retrospective case series across multiple centers to evaluate patients who developed PLA after ERCP for choledocholithiasis. Data was obtained from the Chung Gung Research Database (January 2001 to December 2018). Out of 220 enrolled patients, 195 were categorized in the endoscopic sphincterotomy (ES) group, while 25 were in the non-ES group for further analysis. Results The non-ES group had significantly higher total bilirubin levels compared to the ES group (4.3 ± 5.8 vs 1.9 ± 2.0, p<0.001). Abscess size, location, and distribution (single or multiple) were similar between the two groups. The most common pathogens were Klebsiella pneumoniae and Escherichia coli. Pseudomonas infection was significantly less prevalent in the ES group compared to the non-ES group (3.6% vs 16.7%, p=0.007). Patients with concurrent malignancies (HR: 9.529, 95% CI: 2.667-34.048, p=0.001), elevated total bilirubin levels (HR: 1.246, 95% CI: 1.062-1.461, p=0.007), multiple abscess lesions (HR: 5.146, 95% CI: 1.777-14.903, p=0.003), and growth of enterococcus pathogens (HR: 4.518, 95% CI: 1.290-15.823, p=0.001) faced a significantly higher risk of in-hospital mortality. Conclusion PLA incidence was higher in the ES group compared to the non-ES group following ERCP for choledocholithiasis. Attention should be given to significant risk factors, including concurrent malignancies, elevated total bilirubin levels, multiple abscess lesions, and growth of enterococcus pathogens, to reduce in-hospital mortality.
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Affiliation(s)
- An-Che Liu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Ming Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Fai-Meng Sou
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Obed A, Abuassi M, Alsakarneh S, Jaber F, Fakhri M, Abufares F, Bashir A, Syam M, Jarrad A, Abdelhadi O, Ghoz H. Does Liver Resection Remain a Viable Option in Patients With Pyogenic Liver Abscess? A Single-Center Experience. Gastroenterology Res 2023; 16:184-191. [PMID: 37351080 PMCID: PMC10284645 DOI: 10.14740/gr1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Pyogenic liver abscesses (PLAs) are relatively rare but often fatal if left untreated. Antibiotic therapy combined with percutaneous procedures has replaced surgery as the cornerstone of treatment. However, open surgical drainage or liver resection may be a last resort. This study aimed to review our experience in treating PLA, with a focus on the conditions requiring partial liver resection as the last viable curative option. Medical records of patients with PLA admitted to Jordan Hospital between October 2014 through October 2020 were retrospectively reviewed. Medical and demographic data of all 43 patients admitted to our facility with a diagnosis of PLA were extracted. We reviewed these patients and extracted the cases that required surgical intervention. Four (three males and one female) of the 43 patients with PLA required surgical intervention. The underlying causes of liver abscesses were as follows: one traumatic due to shrapnel injury from an explosion, one following chemoembolization for hepatocellular carcinoma, and two patients with no apparent etiology. All patients were diagnosed with a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Two patients had negative cultures. All patients received broad-spectrum antibiotics, and all underwent CT- or ultrasound-guided percutaneous drainage or aspiration. All four patients required partial hepatic resection due to treatment failure or inaccessible percutaneous procedures with clinical improvement. Although antimicrobial and interventional therapy remains the primary treatment option in PLA, the surgical option with open surgical drainage or partial liver resection remains viable and curative in selected patients.
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Affiliation(s)
- Aiman Obed
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mohammad Abuassi
- Internal Medicine Department, Jordan Hospital, Amman, Jordan
- These authors contributed equally to this study
| | - Saqr Alsakarneh
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
- These authors contributed equally to this study
| | - Fouad Jaber
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mahmoud Fakhri
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Fadi Abufares
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Abdalla Bashir
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mahmood Syam
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Anwar Jarrad
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Ody Abdelhadi
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Hassan Ghoz
- Gastroenterology Department, University of Missouri-Kansas City, Kansas City, MO, USA
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Nahidi SM, Hussaini MS, Mahadeo D, Thet Z. Pyogenic Liver Abscess Growing Streptococcus constellatus in an Elderly Female With Recent Diverticulitis: A Case Report. Cureus 2023; 15:e37004. [PMID: 37139043 PMCID: PMC10151154 DOI: 10.7759/cureus.37004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/04/2023] Open
Abstract
Pyogenic liver abscess (PLA) is known as a pus-filled lesion found in the liver which can quickly become fatal if not found and treated in a timely manner. The most common group of bacteria found in PLA is the Streptococcus Anginosus Group (SAG). Patients with PLA usually present with fever and right upper quadrant abdominal pain which can at times be referred to the right shoulder owing to dermatomal involvement. We present a case where a patient with a past medical history significant for recent diverticulosis presenting with a left lower quadrant abdominal pain, fever, and hypotension and on further workup was found to have a PLA. Blood cultures and cultures from the abscess grew Streptococcus constellatus. This bacteria is part of the SAG group however, it is rarely found in PLA and bloodstream.
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JinHua C, YaMan L, Jian L. Double pigtail tube drainage for large multiloculated pyogenic liver abscesses. Front Surg 2023; 9:1106348. [PMID: 36713673 PMCID: PMC9877412 DOI: 10.3389/fsurg.2022.1106348] [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: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aims to investigate the efficacy and safety of double pigtail tube drainage compared with single pigtail tube drainage for the treatment of multiloculated pyogenic liver abscesses greater than 5 cm. Patients and Methods This study retrospectively analyzed patients with pyogenic liver abscess admitted in the Affiliated Hospital of Chengde Medical College between May 2013 and May 2021. Patients with pyogenic liver abscess more than 5 cm in size, who underwent drainage of the abscess with either double pigtail or single pigtail tube, were included. Results A total of 97 patients with pyogenic liver abscesses larger than 5 cm were studied. These included 34 patients with double pigtail tube drainage and 63 patients with single pigtail tube drainage. The postoperative hospital stay (13.39 ± 4.21 days vs. 15.67 ± 7.50 days; P = 0.045), and time for removal of the catheter (17.23 ± 3.70 days vs. 24.11 ± 5.83 days; P = 0.038) were lower in the double pigtail tube group compared with the single pigtail tube group. The rate of reduction, in three days, of c-reactive protein levels was 26.61 ± 14.11 mg/L/day in the double pigtail tube group vs. 20.06 ± 11.74 mg/L/day in the single pigtail tube group (P = 0.025). The diameter of the abscess cavity at discharge was 3.1 ± 0.07 cm in the double pigtail tube group as compared with 3.7 ± 0.6 cm in the single pigtail tube group (P = 0.047). There was no bleeding in any of the patients despite abnormal coagulation profiles. There was no recurrence of abscess within six months of discharge and no death in the double pigtail tube group. Conclusion: Double pigtail tube drainage treatment in multiloculated pyogenic liver abscesses greater than 5 cm in size, is safe and effective.
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Affiliation(s)
- Cui JinHua
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Liu YaMan
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Li Jian
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China,Correspondence: Li Jian
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Muacevic A, Adler JR. Epidemiology, Clinical Features, and Outcome of Liver Abscess: A Single-Center Experience. Cureus 2022; 14:e29812. [PMID: 36337811 PMCID: PMC9621470 DOI: 10.7759/cureus.29812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Liver abscesses are rare, but whenever they occur, it is predominantly among males over 60 years of age. The paradigm in the treatment has changed, and percutaneous drainage is now the initial treatment for drainage of the abscesses. Open surgery is reserved for patients with septated abscesses and those greater than 5 cm. Objective To study the etiological, clinical, pathological, and demographic characteristics of individuals with liver abscesses and to evaluate the outcome associated with different treatment strategies. Methods This clinico-epidemiological study was carried out at a tertiary care hospital in Jodhpur. One hundred patients with liver abscesses were studied. Patients were assigned to three groups: Group 1 - medical management alone (in non-aspirable uncomplicated abscess), Group 2 - USG-guided needle aspiration or pigtail percutaneous catheter drainage plus medical management (in unruptured aspirable abscess), Group 3 - open surgical drainage plus medical management (In ruptured abscesses). Of the total patients, 36% were treated with medical therapy alone, 45% with USG-guided needle aspiration, 10% with USG-guided percutaneous catheter drainage, and 9% with open surgical drainage. Results In our study, fever and hepatomegaly were the commonest presentations, observed in 91% and 62% of cases, respectively. Escherichia coli (E.coli) was the predominant organism cultured in 28 (43.75%) patients followed by Klebsiella growing in 24 (37.50%) patients. The right lobe was affected more (83%) than the left lobe and in the majority (83%), a solitary abscess was present. The mean age of liver abscess presentation was 40.72 years, with a 5.67:1 male-to-female ratio. Alcohol consumption was reported by 33% of patients, the majority of whom were men. Serum bilirubin was elevated in 56% of liver abscess patients, while it was normal in 44%. The mean serum bilirubin was 2.08 mg/dl. The mean value in group 1, group 2, and group 3 was 1.44 mg/dl, 2.23 mg/dl, and 2.57 mg/dl, respectively. Liver abscesses were identified in 76% of patients with right lobes; 83% had solitary liver abscesses and 17% had numerous abscesses. Abscess culture showed E. coli in 21 (32.81%) and Klebsiella in 17 (26.56%) patients. Conclusion Right-sided solitary pyogenic liver abscess caused by E.coli is the most common liver abscess, with fever and hepatomegaly as the most common presentation. Non-aspirable liver abscesses, regardless of aetiology, can be successfully treated by medical therapy alone. Needle aspiration or catheter drainage is standard for liver abscesses. Thus, needle aspiration has replaced the surgical exploration of liver abscesses.
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Sohrabi M, Alizade Naini M, Rasekhi A, Oloomi M, Moradhaseli F, Ayoub A, Bazargani A, Hashemizadeh Z, Shahcheraghi F, Badmasti F. Emergence of K1 ST23 and K2 ST65 hypervirulent klebsiella pneumoniae as true pathogens with specific virulence genes in cryptogenic pyogenic liver abscesses Shiraz Iran. Front Cell Infect Microbiol 2022; 12:964290. [PMID: 36017366 PMCID: PMC9396702 DOI: 10.3389/fcimb.2022.964290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKp) pathotype is emerging worldwide in pyogenic liver abscesses (PLAs). However, the role of virulence factors in pathogenicity remains unclear. On the other hand, the epidemiology of PLAs in Iran is unknown. From July 2020 to April 2022, bacterial species were isolated and identified from the drainage samples of 54 patients with PLAs. K. pneumoniae as the most common pathogen of pyogenic liver abscesses was identified in 20 (37%) of the 54 patients. We analyzed the clinical and microbiological characteristics of K. pneumoniae-related pyogenic liver abscesses. Antibiotic susceptibility testes and string test were performed. 16S rRNA, antibiotic resistance, and virulence genes were determined by polymerase chain reaction amplification. Clonal relatedness of isolates was identified by multilocus sequence typing. Virulence levels were assessed in the Galleria mellonella larval infection model. Four hvKp isolates (K1/K2) were found to be responsible for cryptogenic PLAs, and 16 classical K. pneumoniae isolates (non-K1/K2) were associated with non-cryptogenic PLAs. Three capsular serotype K1 strains belonged to sequence type 23 (ST23) and one K2 strain to ST65. Meanwhile, the non-K1/K2 strains belonged to other STs. ST231 was the most common strain among the classical K. pneumoniae strains. Compared with the non-K1/K2 strains, capsular serotypes K1/K2 strains were less resistant to antibiotics, had positive string test results, and had more virulence genes. In Galleria mellonella, a concentration of 106 colony-forming units of the K1 hvKp strain resulted in 100% death at 24 hours, confirming the higher virulence of the hvKp strain compared with cKp. K. pneumoniae isolates represented that the acquisition of any plasmid or chromosomal virulence genes contributes to pathogenicity and high prevalence in PLAs. Meanwhile, hvKp isolates with a specific genetic background were detected in cryptogenic PLAs.
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Affiliation(s)
- Maryam Sohrabi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Mahvash Alizade Naini
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mana Oloomi
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran
| | - Farzad Moradhaseli
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Ayoub
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdollah Bazargani
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Hashemizadeh
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Shahcheraghi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
- *Correspondence: Farzad Badmasti, ; Fereshteh Shahcheraghi,
| | - Farzad Badmasti
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
- *Correspondence: Farzad Badmasti, ; Fereshteh Shahcheraghi,
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Bsat A, Ataya K, Osman B, Hafez B, Kanafani D, Hallak R, Khalife MJ. Indirect ballistic injury to the liver resulting in retained bullet complicated with hepatic abscess: a case report. J Surg Case Rep 2022; 2022:rjac261. [PMID: 35873188 PMCID: PMC9300046 DOI: 10.1093/jscr/rjac261] [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: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Indirect and extraperitoneal penetrating liver injury is an extremely uncommon phenomenon. In this report, we highlight the case of an 18-year-old male patient that sustained a gunshot wound with an entry site through the right buttock and landed in the liver. He presented to us in sepsis due to developing a hepatic abscess at the site of the dislodged bullet that was confirmed with computed tomography. Interestingly, the ballistic missile did not cause any visceral injury due to its indirect and extraperitoneal trajectory. The patient underwent diagnostic laparoscopy, where the hepatic abscess was unroofed and evacuated. A free-floating bullet was found and extracted, and a small bile duct leak was repaired. The patient had an uneventful post-operative course and was duly discharged on an empiric course of antibiotics.
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Affiliation(s)
- Ayman Bsat
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Karim Ataya
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Bassam Osman
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Basel Hafez
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Dana Kanafani
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Razan Hallak
- Department of Neurology, American University of Beirut Medical Center , Beirut , Lebanon
| | - Mohamad Jawad Khalife
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
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11
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Syed HR, Tellez Watson P. Giant Liver Infections: Cryptogenic Liver Abscess Secondary to Bacteroides Fragilis. Cureus 2022; 14:e26283. [PMID: 35911315 PMCID: PMC9312942 DOI: 10.7759/cureus.26283] [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: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
Hepatic abscesses are a seldom finding although they are the most common type of intraabdominal abscess. We find that this localized collection of pus can be a result of bacteria, ameba, or fungi. This study will mainly focus on the first type, the pyogenic liver abscess (PLA), in which management is predicated on size of abscess. There is no standard definition as to what constitutes a small or large hepatic abscess. Here, we present a case of a 10 cm PLA found in the right lobe of the liver. We aimed to discuss the relevant epidemiology, pathophysiology, clinical manifestations, and management of PLAs.
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12
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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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13
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Maraki S, Mavromanolaki VE, Stafylaki D, Anagnostopoulou E, Moraitis P, Kasimati A, Treptow B. A 60-Year Literature Review on Hepatic Actinomycosis. Med Princ Pract 2022; 31:103-110. [PMID: 35038716 PMCID: PMC9209987 DOI: 10.1159/000521990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatic actinomycosis (HA) is a rare infection with an indolent course, atypical clinical manifestations, nonspecific laboratory and imaging findings, and challenging diagnosis. We describe a case of a 35-year-old female who developed HA 2 weeks after gastrectomy. In addition, we analyzed clinical characteristics and outcome of 157 additional cases of HA identified in a 60-year literature review. Patients with HA were predominantly male (57%) and more than one-half were between 40 and 70 years of age. The infection was cryptogenic in 80.8% of cases. Risk factors for HA were identified in 63.1% of the patients. Clinical presentation included fever (57.7%), abdominal pain (52.1%), weight loss (45.1%), anorexia (27.5%), fatigue and chills (12.7% each), and malaise (12%) over a 2.35 ± 3.5 months period. Leukocytosis, elevated alkaline phosphatase, erythrocyte sedimentation rate, and C-reactive protein were the most frequent laboratory findings. Radiologic imaging revealed that the right lobe was more frequently affected (62.5%) with a single lesion found in two-thirds of cases. Diagnosis was achieved by histopathologic examination in 70.6% of cases. Cultures yielded Actinomyces in 45 instances, with A. israelii being the most frequent species. Less than one-half of the patients were treated only with antibiotics, while the others received combined medical and surgical treatment. The median duration of antibiotic therapy was 135 days. The presence of multiple lesions or solid tumor-like lesions (without liquefaction) was significantly associated with medical therapy alone. The outcome was favorable in most cases (94%). Although rarely encountered, HA should be considered in patients with a chronic or subacute inflammatory process of the liver to promptly diagnose and treat.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
- *Sofia Maraki,
| | | | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Eliza Anagnostopoulou
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - Panagiotis Moraitis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Anna Kasimati
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Boris Treptow
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Greece
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14
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Boaz E, Ben-Chetrit E, Bokhobza Y, Yellinek S, Ben-Haim M, Reissman P, Dagan A. Pyogenic Liver Abscess: Contemporary Trends in a Tertiary Institute. Int J Clin Pract 2022; 2022:4752880. [PMID: 36567774 PMCID: PMC9750783 DOI: 10.1155/2022/4752880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. In recent years, advances in diagnostics and management have led to early diagnosis and treatment and decreased mortality. We present recent data from a large series of patients with PLA and examine the trends in the management of PLA over a period of 50 years. METHODS The medical records of all patients admitted to the Shaare Zedek Medical Center, Israel, between January 2011 and December 2021 with a primary or secondary diagnosis of PLA were reviewed retrospectively. RESULTS : Ninety-five patients with PLA were identified. Thirty-eight (40%) were female. The median patient age was 66 years (range 18-93). The diagnosis of PLA in all patients was confirmed with abdominal computed tomography (CT). In twenty patients (21.1%), PLA was not diagnosed by the initial abdominal US. Most abscesses were right-sided. Biliary tract origin was the most common underlying cause of PLA (n = 57, 60%), followed by cryptogenic etiology (n = 28, 30%). Escherichia coli, Klebsiella pneumoniae, and Streptococcus species were most commonly identified. The most common primary treatment modality was percutaneous drainage (PD), which was performed in 81 patients (85.3%). Fourteen patients (14.7%) were treated medically without intervention, and two patients (2.1%) were treated surgically following a failure of PD. Four patients died as a direct result of PLA. CONCLUSIONS Patients diagnosed with PLA are older, the male predominance is less pronounced, and the offending pathogens are likely to originate from the biliary tract. This study questions the utility of abdominal US as the initial diagnostic imaging in patients with suspected PLA (versus CT) and demonstrates improved outcomes for patients with PLA over the years.
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Affiliation(s)
- Elad Boaz
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Faculty of Medicine, Hebrew University of Jerusalem, Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Yonathan Bokhobza
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Shlomo Yellinek
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Menahem Ben-Haim
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Petachia Reissman
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
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15
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Balogun O, Jeje E, Fatuga A, Atoyebi O. An unusual cause of pyogenic liver abscess. The conundrum of broom splinter. Report of two cases. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Chan KS, Shelat V. Pyogenic Liver Abscess. THE IASGO TEXTBOOK OF MULTI-DISCIPLINARY MANAGEMENT OF HEPATO-PANCREATO-BILIARY DISEASES 2022:509-519. [DOI: 10.1007/978-981-19-0063-1_66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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17
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Zhang J, Wang T, Fang Y, Wang M, Liu W, Zhao J, Wang B, Wu Z, Lv Y, Wu R. Clinical Significance of Serum Albumin/Globulin Ratio in Patients With Pyogenic Liver Abscess. Front Surg 2021; 8:677799. [PMID: 34917645 PMCID: PMC8669143 DOI: 10.3389/fsurg.2021.677799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022] Open
Abstract
Pyogenic liver abscess (PLA) remains a significant challenge for modern clinicians. Serum albumin/globulin ratio (AGR) can reflect the progress of many diseases. However, the clinical significance of AGR in PLA has not been evaluated. The aim of this study was to explore the effect of AGR on the clinical characteristic and prognosis in PLA patients. This retrospective study included 392 PLA patients who admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January, 2007 to December, 2016. The medical records on admission were collected. Compared with the healthy controls and the patients with extraperitoneal infection or non-infectious liver disease, PLA patients had lower levels of AGR. The mean level of AGR in PLA patients was 1.02 ± 0.25. There were 179 (45.4%) patients with AGR > 1.02 and 213 (54.6%) patients with AGR ≤ 1.02. The baseline data and treatment plans of PLA patients with high or low AGR were comparative. However, PLA patients with a low AGR had higher body temperature, leukocytes and neutrophils, lower hemoglobin, poorer liver and coagulation function, larger abscess diameter, higher positive rate of pus culture and proportion of Escherichia coli, and were more susceptible to multiple bacteria. Moreover, PLA patients with a low AGR had more complications, including systemic inflammatory response syndrome (SIRS), peritoneal effusion and pleural effusion. And it also needs longer time for temperature normalization and hospital stay. In conclusion, PLA patients have lower AGR and lower AGR is associated with worse clinical manifestations, more complications and poorer prognosis. Thus, monitoring of AGR is of great clinical significance for evaluating the progress of PLA patients.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Fang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengzhou Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wuming Liu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junzhou Zhao
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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18
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Liver Abscesses in Tropics. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Brewer SK, Patel P, Kesiry R. An Unusual Case of Obstructive Jaundice Secondary to Pyogenic Liver Abscesses. Cureus 2021; 13:e16409. [PMID: 34408957 PMCID: PMC8363172 DOI: 10.7759/cureus.16409] [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] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Pyogenic liver abscesses (PLA) are an uncommon, but potentially life-threatening infection. Although the link between amebic liver abscesses and obstructive jaundice is well documented, there are few cases of PLA leading to this complication. We present a case of multiple massive PLA and obstructive jaundice on initial presentation. The patient was treated for six weeks with antibiotics and percutaneous drains placed in the largest abscesses and was discharged after clinical improvement and resolution of the hyperbilirubinemia. This case highlights the importance of clinician awareness of other etiologies when evaluating patients with signs and symptoms of painful obstructive jaundice.
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Affiliation(s)
- Shannon K Brewer
- Internal Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Pranav Patel
- Internal Medicine, Medical City Weatherford, Weatherford, USA
| | - Riad Kesiry
- Internal Medicine, Medical City Weatherford, Weatherford, USA
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20
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Abstract
Introduction: Pyogenic liver abscess (PLA) is a serious infectious disease of the liver. Pyogenic liver abscess caused by Fusobacterium nucleatum is extremely rare. Here we report the first case of liver abscess caused by F. nucleatum in China. Case Presentation: The case was a 34-year-old female patient admitted to the hospital due to high fever. The diagnosis of liver abscess was confirmed by imaging studies and liver puncture. We finally confirmed the pathogen as F. nucleatum by next-generation sequencing (NGS). After the targeted anti-infective treatment, the patient recovered and discharged. Conclusions: As a new microbial detection method, NGS can still help in clinical practice. In addition, to improve the positive rate of anaerobic bacteria culture, we should pay attention to avoid contact with air in the process of specimen collection when the pathogenic bacteria are suspected to be anaerobic bacteria.
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21
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Wu CK, Hsu CN, Cho WR, Yang SC, Liu AC, Tai WC, Lee CH, Yang YH, Chuah SK, Liang CM. Increased Risk of Pyogenic Liver Abscess after Endoscopic Sphincterotomy for Treatment of Choledocholithiasis. Infect Drug Resist 2021; 14:2121-2131. [PMID: 34135602 PMCID: PMC8197570 DOI: 10.2147/idr.s312545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aim Endoscopic sphincterotomy (ES) abolished the barrier between the hepatobiliary system and duodenum and might be at risk of pyogenic liver abscess (PLA). We aimed to identify the association factors of PLA in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) procedures for treatment of choledocholithiasis. Methods This study was based on the Chung Gung Research Database (CGRD) between January 1, 2001 and December 31, 2018. Those who had an International Classification of Diseases, Ninth and Tenth Revision (ICD9 and ICD10) codes of choledocholithiasis and received ERCP were enrolled. After strict exclusions, 11,697 patients were further divided into the endoscopic sphincterotomy (ES) group (n=7,111) and other ERCP group (n=4,586) for analysis. Results Patients receiving ES had significantly higher rates of PLA than those of the other ERCP group (5-year cumulative incidence 2.4% versus 1.7%; 10-year cumulative incidence 3.9% versus 3.2%, log-rank p=0.0177). Aging, male gender, surgery for hepato-pancreato-biliary system and hepatobiliary malignancy were significant association factors of PLA. On multivariate analysis, the ES increased the risk of PLA (adjusted hazard ratio [aHR]=1.49; 95% CI=1.12-1.98; p=0.0058) but decreased the risks for acute pancreatitis (aHR=0.72; 95% CI=0.60-0.85; p=0.0002) and cholangitis (aHR= 0.91; 95% CI=0.84-0.99; p=0.0259). There was no significant difference about recurrent choledocholithiasis between groups. Conclusion This study demonstrated a significant risk of PLA after patients receiving ES compared with the other ERCP group. We should also carefully monitor the association factors of PLA after ERCP treatment of choledocholithiasis including aging, male gender, surgery for the hepato-pancreato-biliary system and hepatobiliary malignancy.
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Affiliation(s)
- Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ru Cho
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Che Liu
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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22
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Song H, Wang X, Lian Y, Wan T. Analysis of the clinical characteristics of 202 patients with liver abscess associated with diabetes mellitus and biliary tract disease. J Int Med Res 2021; 48:300060520949404. [PMID: 32865074 PMCID: PMC7469731 DOI: 10.1177/0300060520949404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Clinical characteristics of patients with pyogenic liver abscess (PLA) of varying etiologies may be different. This study aimed to analyze the clinical characteristics, pathogenic bacteria, treatment, and prognosis of patients with PLA associated with diabetes and biliary disease. METHODS Clinical, imaging, and laboratory data from 202 inpatients with PLA were retrospectively analyzed. RESULTS Eighty-eight patients (43.6%) had a history of diabetes, 73 (36.1%) had a history of underlying biliary tract disease, and 24 (11.9%) had both the diseases. The level of C-reactive protein (CRP) increased in 99.2% (119/120) patients, and the level of procalcitonin (PCT) increased in 95.5% (148/155) patients. The main pathogen of PLA was Klebsiella pneumoniae. The incidence of bloodstream infection increased by 34.4% (22/64) in patients with PLA that was associated with diabetes mellitus, and that of K. pneumoniae infection was 88.6% (39/44). The readmission rate for patients with PLA with underlying biliary diseases was 10.2 to 12.5%. CONCLUSION The main pathogen of PLA is K. pneumoniae, which is sensitive to most antibiotics. Patients with PLA associated with diabetes were more likely to have bloodstream infections, and the recurrence rate of PLA with underlying biliary diseases was higher than without biliary duct disease.
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Affiliation(s)
- Huiwen Song
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Xianbin Wang
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Yubao Lian
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Tuer Wan
- Department of Imaging Medicine, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
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23
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Mohanty S, Firdaus S, Mohanty RR. Stenotrophomonas maltophilia: An uncommon cause of liver abscess. IDCases 2021; 24:e01125. [PMID: 33948437 PMCID: PMC8080464 DOI: 10.1016/j.idcr.2021.e01125] [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: 01/21/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022] Open
Abstract
We report an uncommon case of pyogenic liver abscess due to Stenotrophomonas maltophilia in an apparently immune-competent individual, the timely recognition of which could avoid a potentially fatal course of infection in the patient. A 45-year-old man, with history of moderate alcohol intake since the last 10 years, was admitted with intense right-sided upper abdominal pain and right-sided chest pain of 10-days duration. Culture of the ultrasound-guided liver aspirate sample yielded a pure growth of S. maltophilia identified by the VITEK-2™ automated microbial identification system. Treatment with parenteral levofloxacin and oral trimethoprim-sulfamethoxazole along with pigtail catheter drainage and other appropriate supportive management led to resolution of the abscess with no recurrence of infection at two months follow-up. Physicians need to be aware that S. maltophilia infections may not be restricted to hospitalized patients as a low-virulence opportunistic pathogen, but may occur as an important emerging pathogen in community-acquired infections as well.
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Affiliation(s)
- Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Shehnaz Firdaus
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Rashmi Ranjan Mohanty
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
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24
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Wolf R, Smolinski-Zhao S. Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist. Semin Intervent Radiol 2021; 38:131-138. [PMID: 33883810 DOI: 10.1055/s-0041-1726003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In addition to acute injury requiring interventional radiologic treatments, patients with traumatic injuries can develop delayed or chronic complications. These injuries can involve nearly all solid organs in the abdomen. Coupled with significant improvements in visualizing these injuries with advanced imaging techniques such as minimally invasive procedures, nonoperative management of both acute traumatic injuries and their longer term sequelae has become the norm. This article reviews frequently seen complications of traumatic injury and their management by interventional radiologists.
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Affiliation(s)
- Robert Wolf
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sara Smolinski-Zhao
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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25
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Nyabera A, Shaban L, Hijazin K, Tumarinson T. Community-Acquired Methicillin-Resistant Staphylococcus Aureus Hepatic Liver Abscess. Cureus 2021; 13:e12560. [PMID: 33564551 PMCID: PMC7863055 DOI: 10.7759/cureus.12560] [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] [Indexed: 11/05/2022] Open
Abstract
A methicillin-resistant Staphylococcus aureus (MRSA) liver abscess is a rare infection that if not recognized, and treated early, can be fatal. There is limited literature demonstrating possible etiologies of MRSA liver abscesses, whether nosocomial or community acquired. We present a case of a 45-year-old Guyanese male with a 30 pack-year smoking history. The patient presented with both generalized abdominal pain and a productive cough on two separate occasions. Laboratory results in his second presentation revealed leukocytosis with increased alanine transaminase (ALT). Imaging revealed a multiloculated abscess in the inferior aspect of the liver, measuring 5.1 cm x 3.4 cm x 4 cm, and chest X-ray revealed developing consolidation within the right perihilar region. The patient underwent percutaneous liver drainage via pigtail catheter. Fluid cultures grew MRSA. The patient was placed on vancomycin for three weeks. On subsequent examinations, there was a resolution of leukocytosis with no drainage from the pigtail catheter. Elevations of aspartate transaminase (AST), ALT, and gamma-glutamyl transferase (GGT) were observed. Therefore, in addition to restarting vancomycin, the patient was started on ciprofloxacin for two weeks and liver function tests (LFTs) trended downwards, without recurrence of symptoms. High suspicion for liver abscess should exist in patients that present with complaints of abdominal pain and elevated LFTs when a previous source of infection has been observed. MRSA liver abscesses are rare and potentially fatal, therefore, early recognition and appropriate management is essential.
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Affiliation(s)
- Akwe Nyabera
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Lilia Shaban
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Kristin Hijazin
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Taisiya Tumarinson
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Infected hepatic cyst complicating urinary sepsis. Acta Gastroenterol Belg 2021; 84:131-134. [PMID: 33639705 DOI: 10.51821/84.1.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Congenital hepatic cysts are a common disorder. Usually they are asymptomatic and do not have to be treated. However, some serious complications can occur. We report here the case of an 86-year old patient who has been treated by a percutaneous drainage for an infected solitary hepatic cyst due to urinary sepsis. She was admitted to the Department of Internal Medicine for epigastric pain with fever and chills. The patient was treated for a urinary tract infection 3 weeks ago by her General Practitioner. On admission, blood tests showed 21 620 neutrophils per microliter with a C-reactive protein level at 443.7 mg/L, procalcitonin > 200 ng/mL, total bilirubin at 1.43 mg/dL, lactate dehydrogenase at 666 U/L and alanine aminotransferase at 227 U/L. Urinalysis and hemocultures highlighted the presence of Escherichia coli and Streptococcus constellatus. The abdominal tomodensitometry indicated the presence of a left hepatic biliary cyst with banal appearance. She was first treated with intravenous amoxicillin clavulanic acid. After a few days, another abdominal tomodensitometry with contrast pinpointed a large abscess of 11 centimeters in diameter extending to liver segments II and IV with a similar small lesion in segments IV and V. clindamycin per os was added to the treatment because of its good diffusion in tissues. Percutaneous drain was inserted under tomodensitometric control and stayed in place until the follow-up at three weeks. Bacteriologic culture on the fluid sample demonstrated the presence of Escherichia coli and Streptococcus constellatus. The abscess completely regressed after 6 weeks of treatment and the biologic abnormalities resolved at the same time.
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Navarrete D, Patil S, Dandachi D. Acute Streptococcus constellatus Pyogenic Liver Abscess Due to an Atypical Presentation of Sigmoid Diverticulitis Complicated by Pericolonic Abscess. Cureus 2020; 12:e10940. [PMID: 33200054 PMCID: PMC7661007 DOI: 10.7759/cureus.10940] [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] [Indexed: 12/18/2022] Open
Abstract
Diverticulitis is a result of diverticulum inflammation that involves protrusion of the colonic wall. It is considered to be complicated when associated with an abscess, fistula, perforation of large bowel, or obstruction. The incidence of diverticulitis increases with age, and it most commonly presents as constant abdominal pain in the left lower quadrant. We report a case of a 54-year-old male with a history of hypertension who was admitted to our hospital with systemic symptoms and right shoulder pain noted to have Streptococcus constellatus bacteremia and an incidental finding of a single large hepatic abscess on chest imaging. Additional imaging studies revealed the presence of acute sigmoid diverticulitis complicated by pericolonic abscess. He had no known risk factors and had not experienced any abdominal pain before admission. A liver abscess due to S. constellatus is a rare complication from sigmoid diverticulitis, and there are only a few cases reported as per the PubMed medical literature review. Only four other unique cases with few or no risk factors were discovered to have a pyogenic liver abscess initially, and later source was found to be due to perforated diverticulitis. Due to this rare clinical presentation, diagnosis is often delayed leading to complications requiring surgical intervention. This can result in higher mortality. Our patient had ultrasound-guided drainage of the abscess and completed a six-week course of intravenous antibiotics (ceftriaxone and metronidazole) with successful recovery.
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Affiliation(s)
| | - Sachin Patil
- Infectious Disease, University of Missouri, Columbia, USA
| | - Dima Dandachi
- Infectious Disease, University of Missouri, Columbia, USA
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Wang L, Yuan M, Lu Q. Ruptured pyogenic liver abscess with Pneumoperitoneum following pancreaticoduodenectomy. Asian J Surg 2020; 43:1110-1112. [PMID: 32883569 DOI: 10.1016/j.asjsur.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lei Wang
- Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Maoling Yuan
- Geriatrics, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
| | - Qicheng Lu
- Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
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Basquez RL, Butt I, Billings A, Pippin M. Liver Abscess Caused by Ingestion of a Sewing Needle. Cureus 2020; 12:e8924. [PMID: 32760625 PMCID: PMC7392365 DOI: 10.7759/cureus.8924] [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] [Indexed: 11/13/2022] Open
Abstract
Liver abscesses have a low incidence and can be caused by multiple etiologies. We present an interesting case of a 74-year-old woman who presented with abdominal pain and leukocytosis. Imaging revealed a foreign body in the antrum of the stomach extending to an area of hypodensity in the liver. She was taken for an exploratory laparotomy and was found to have a gastric perforation due to a sewing needle. The needle had embedded in the liver causing the formation of an abscess. The patient was successfully treated with surgical management and a course of antibiotics.
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Trillos-Almanza MC, Restrepo Gutierrez JC. How to manage: liver abscess. Frontline Gastroenterol 2020; 12:225-231. [PMID: 33912334 PMCID: PMC8040501 DOI: 10.1136/flgastro-2019-101240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/28/2019] [Accepted: 12/24/2019] [Indexed: 02/04/2023] Open
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Study of ultrasound-guided needle aspiration and catheter drainage in the management of liver abscesses. J Ultrasound 2020; 23:553-562. [PMID: 32221809 DOI: 10.1007/s40477-020-00440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate and compare the efficacy of intermittent needle aspiration and continuous catheter drainage in ultrasound-guided management of liver abscesses. METHODS This was a prospective, randomised study conducted on 100 patients (88 males and 12 females; age range 22-74 years) with liver abscess(es) and having abscess size more than 5 cm, divided into two groups: Percutaneous needle aspiration (PNA) (n = 50) and percutaneous catheter drainage (PCD) (n = 50). Criteria of exclusion were: rupture of abscess before intervention; prior intervention; uncorrectable coagulopathy; concomitant biliary tract malignancy. In the PNA group, pus was aspirated by an 18-gauge needle using freehand technique and the number of aspirations was limited to two. Failure of abscess size to decline below 50% of the original diameter or of clinical improvement after second aspiration was considered as failure of aspiration. In the PCD group, drainage was done by 12-French catheters using Seldinger technique. Drainage was considered as failure if abscess cavity did not resolve and laparotomy was needed to evacuate the pus cavity. RESULT The success rate in the PNA group was 88% and 92% in the PCD group; however, this difference was statistically not significant, suggesting that both are equally efficacious. The total duration of hospital stay (mean 6.8 days [PNA] vs 10.5 days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9 days [PNA] vs 10.2 days [PCD]; p value:0.026) were significantly less in the PNA group. One major complication was seen in our study: peritonitis due to peri-catheter leak in PCD group. CONCLUSION Both procedures are equally efficacious in the management of liver abscesses; however in view of less duration of hospital stay, patient safety and comfort, procedure simplicity, and the reduced cost, needle aspiration should be used as the first-line procedure in the treatment of liver abscess (even in abscesses more than 5 cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.
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Perween N, Kumar S, Omar B, Kothari A, Satsangi A, Jha M, Mohanty A. Pyogenic liver abscess: Clinical features and microbiological profiles in tertiary care center. J Family Med Prim Care 2020; 9:4337-4342. [PMID: 33110856 PMCID: PMC7586609 DOI: 10.4103/jfmpc.jfmpc_927_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Pyogenic liver abscess (PLA) is the end result of a number of pathologic processes that cause a suppurative infection of the liver parenchyma. Materials and Methods: Sixty-five patients of age more than 18 years and radiologically confirmed cases of liver abscess were included in this study. Pus and blood samples were collected. Pus was processed for microscopy of trophozoite of Entamoeba histolytica and aerobic and anaerobic bacterial culture. Blood was processed for antibody ELISA for Entamoeba histolytica and aerobic bacterial culture. Identification of aerobic and anaerobic isolates was done by Vitek2 and antibiotic sensitivity test for aerobic bacterial isolates was done by Vitek2. Result: Out of sixty five, twenty five were confirmed as PLA. All patients were male with mean age 37.9 years. Fever and upper abdominal pain were the most common symptoms. Right lobe comprised 80% of the abscess. Pus sample was more sensitive than blood sample for diagnosis. There were a total of 33 isolates in our study. Klebsiella pneumoniae (6/33) was the most common aerobic isolate and Clostridium spp. (7/33) was the anaerobic isolate. All gram-negative bacteria were showing good sensitivity for 3rd and 4th generation cephalosporins, fluoroquinolones, amikacin, gentamicin, piperacillin-tazobactam, imipenem and meropenem. Abscess >5 cm was treated with percutaneous drainage while abscess <5 cm was treated with antibiotics only. Conclusion: Diagnosis should be made with the combination of clinical suspicion, radiology, and microbiology. Empirical therapy should include anaerobic coverage too. Only antibiotic therapy can be given under consideration of size of abscess, persistence of fever after giving antibiotics, and any suspected complications.
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Evaluation of clinical risk factors for developing pleural empyema secondary to liver abscess. BMC Gastroenterol 2019; 19:215. [PMID: 31842761 PMCID: PMC6915871 DOI: 10.1186/s12876-019-1128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess. METHODS Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed. RESULTS A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6 ± 6.35 days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR = 2.30, p = 0.048), and larger diameter of the liver abscess (OR = 1.02, p = 0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR = 10.62, p = 0.044), bilateral pleural effusion (OR = 46.72, p = 0.012) and combined biliary tract inflammation (OR = 21.05, p = 0.040) were significantly associated with the need for invasive intervention including surgery on effusion. CONCLUSION The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.
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Faraone A, Fortini A. Elderly man with Streptococcus anginosus bacteremia: diagnostic and therapeutic approach. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Neill L, Edwards F, Collin SM, Harrington D, Wakerley D, Rao GG, McGregor AC. Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess. BMC Infect Dis 2019; 19:490. [PMID: 31159769 PMCID: PMC6547479 DOI: 10.1186/s12879-019-4127-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. Methods Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years. Results One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37–51 years) than those with PLA (median 68, IQR 50.5–78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00–6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19–19.2) per log10 increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. Conclusions Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases. Electronic supplementary material The online version of this article (10.1186/s12879-019-4127-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Neill
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.
| | - Frances Edwards
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Simon M Collin
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - David Harrington
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Dominic Wakerley
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Guduru Gopal Rao
- Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
| | - Alastair C McGregor
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
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Successful Use of Tissue Plasminogen Activator in an Adolescent Male with Pyogenic Liver Abscess. Case Rep Crit Care 2019; 2019:5735312. [PMID: 31161070 PMCID: PMC6487166 DOI: 10.1155/2019/5735312] [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: 11/24/2018] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Large pyogenic liver abscess is a rare and difficult to treat entity in pediatric patients. Percutaneous drainage rather than open surgical drainage has become more common in recent years, even for large abscesses. Percutaneous drainage can be complicated by catheter obstruction. We present the case of a 16-year-old male presenting with abdominal pain, fever, and chills. He was diagnosed with a 9-centimeter liver abscess. A CT-guided percutaneous drainage was placed. The catheter initially drained well, but then became occluded. Tissue plasminogen activator was instilled into the catheter every 6 hours for a total of five doses, resulting in increased drainage and improved clinical state of the patient. To our knowledge, this is the first reported use of tissue plasminogen activator in pyogenic liver abscess in the pediatric population.
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Khilnani, GC, Zirpe, K, Hadda, V, Mehta, Y, Madan, K, Kulkarni, A, Mohan, A, Dixit, S, Guleria, R, Bhattacharya, P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med 2019; 23:S1-S63. [PMID: 31516211 PMCID: PMC6734471 DOI: 10.5005/jp-journals-10071-23101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
How to cite this article: Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian Journal of Critical Care Medicine 2019;23 (Suppl 1):1-63.
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Affiliation(s)
- GC Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Vijay Hadda,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Mehta,
- Indian Society of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesiology, Gurugram, Haryana, India
| | - Karan Madan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kulkarni,
- Department of Anaesthesiology, Division of Critical Care Medicine, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Mohan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Subhal Dixit,
- Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Randeep Guleria,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Bhattacharya,
- Department of Anaesthesiology, Critical Care and Emergency Services, Bhopal, Madhya Pradesh, India
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Pyogenic Liver Abscess with No Predisposing Risk Factors. Case Rep Gastrointest Med 2018; 2018:9509356. [PMID: 30254771 PMCID: PMC6142760 DOI: 10.1155/2018/9509356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/19/2018] [Indexed: 01/19/2023] Open
Abstract
Pyogenic liver abscesses (PLA) are an uncommon cause of hospitalization in the United States. The majority of such cases are polymicrobial and are most commonly caused by seeding of infection from the biliary system. PLA is frequently associated with specific comorbidities such as diabetes mellitus, history of liver transplant, underlying hepatobiliary, or pancreatic disease. Herein, we describe a 47-year-old healthy male with no known risk factors associated with PLA who presented to the hospital with acute fever, abdominal pain, and dark colored urine. Initially the patient had a negative right upper quadrant ultrasound. However, the patient continued to have persistent fevers and abnormal liver biochemistries with negative liver serology that led to checking a magnetic resonance cholangiopancreatography which suggested multiple liver abscesses. Computer tomography guided aspiration revealed a monobacterial Streptococcus species within the abscess, which is commonly associated with arterial bacteremia as a source of PLA. Arterial bacteremia is one of most rare causes of PLA. The patient's septic workup was negative for any source of infection. This case demonstrates a patient with no risk factors who was diagnosed with PLA caused by apparent arterial bacteremia with no clear source of infection.
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Pais-Costa SR, Araujo SLM, Figueiredo VN. HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1394. [PMID: 30133686 PMCID: PMC6097179 DOI: 10.1590/0102-672020180001e1394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. AIM To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. METHODS Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). RESULTS The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. CONCLUSION Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.
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Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, Melchio R, Fenoglio LM. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore) 2018; 97:e0628. [PMID: 29742700 PMCID: PMC5959441 DOI: 10.1097/md.0000000000010628] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pyogenic liver abscess (PLA) are space-occupying lesions in the liver associated with high morbidity and mortality. The aim of this study is to review an Italian hospital experience in epidemiological, clinical patterns, and management of PLA.We performed a retrospective, descriptive case series at a single center assessing demographic characteristics, presentation patterns, etiological factors, microbiological etiology, and management for patients treated for PLA between 2000 and 2016.Around 109 patients were identified. The majority of patients presented with fever (73%); right upper abdominal pain in 63.3%, vomiting and nausea in 28.4%. The most common laboratory abnormality among included items was increased C-reactive protein and fibrinogen blood levels, respectively, in 98% and 93.9% of cases. Abdominal ultrasound was the diagnostic investigation in 42.4% of cases; CT scan and MR imaging were performed in 51.1% and 3.3% of cases respectively. We observed blood or pus culture study in 99 cases of which only 53.5% came with positive microbial reports. The most common organism identified was Escherichia coli (26.5%), followed by Streptococcus spp (13.2%). Early antibiotic treatment started on all patients and 66.7% of cases required different approaches, Ultrasound or CT-guided needle aspiration of PLA was performed in 13 patients (11%) and percutaneous abscess drainage was performed on 72 patients (67%).PLA is a diagnostically challenging problem due to nonspecific presenting characteristics. The microbiological yield identified was a typical European spectrum with a preponderance of Escherichia coli infections. Once recognized, percutaneous drainage and antibiotic treatment are the mainstay of management for PLA.
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Affiliation(s)
- Cristina Serraino
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
| | - Chiara Elia
- Department of Emergengy Medicine, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Christian Bracco
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
| | - Gianluca Rinaldi
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
| | - Fulvio Pomero
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
| | - Alberto Silvestri
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
| | - Remo Melchio
- Department of Internal Medicine, Santa Croce and Carle Hospital, Cuneo
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Mohanty S, Panigrahi MK, Turuk J, Dhal S. Liver Abscess due to Streptococcus constellatus in an Immunocompetent Adult: A Less Known Entity. J Natl Med Assoc 2018; 110:591-595. [PMID: 30129495 DOI: 10.1016/j.jnma.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora. CASE The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up. CONCLUSIONS The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.
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Affiliation(s)
- Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Jyotirmayee Turuk
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Sagarika Dhal
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
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42
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Clostridium tertium: An Unusual Cause of Pyogenic Liver Abscess. ACG Case Rep J 2018; 5:e30. [PMID: 29670926 PMCID: PMC5895462 DOI: 10.14309/crj.2018.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022] Open
Abstract
Pyogenic liver abscess (PLA) is the result of portal vein pyemia, which usually originates from the hepatobiliary system or the gastrointestinal tract. Gram-negative organisms are the most common causative pathogens in PLA. Clostridium tertium is an anaerobic gram-positive, low-virulence organism that most commonly affects neutropenic patients with hematological malignancy and has not been reported to cause PLA. We report an unusual presentation of a C. tertium infection as a PLA in a previously healthy, immunocompetent patient with no identifiable source of portal pyemia.
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Zhang RG, Zhang XL, Yang YS. Alcoholization of pyogenichepatic abscess with absolute alcohol in Bama minipigs. Exp Ther Med 2017; 14:4483-4488. [PMID: 29067123 DOI: 10.3892/etm.2017.5022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/26/2017] [Indexed: 11/05/2022] Open
Abstract
Pyogenic hepatic abscess (PHA) is a rare, but potentially serious disease. At present, ultrasound-guided or computed tomography-guided percutaneous needle aspiration or catheter drainage is appropriate as a first-line treatment. However, it is difficult to aspirate or drain pus and to select the appropriate antibiotic therapy if the abscess consists of thick pus and polymicrobial confections, or its pathogenic bacterium is multidrug resistant and cryptogenic. Case studies of alcoholization provide a novel method to manage PHA. However, the efficacy and safety of this treatment should be further evaluated. In the present study, the therapeutic efficacy and complications of alcoholization for PHAs in Bama minipigs were investigated. PHAs were prospectively treated by ultrasound-guided percutaneous instillation of absolute alcohol in the abscess cavity. The criteria for considering a successful intervention were met in all minipigs subsequent to alcoholization twice within 14 days. The procedures were well tolerated in all animals, and there were no alcoholic adverse effects or procedure-associated complications. In conclusion, ultrasound-guided percutaneous alcoholization is a safe and effective procedure to manage PHA. The problems of thick pus aspiration and selection of an appropriate antibiotic observed in other treatments were resolved effectively using alcoholization. This technique may reduce the treatment period and possibly become a novel strategy for the management of PHA.
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Affiliation(s)
- Ru-Gang Zhang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xiu-Li Zhang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yun-Sheng Yang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China
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44
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Rismiller K, Haaga J, Siegel C, Ammori JB. Pyogenic liver abscesses: a contemporary analysis of management strategies at a tertiary institution. HPB (Oxford) 2017; 19:889-893. [PMID: 28693978 DOI: 10.1016/j.hpb.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite equivocal evidence, non-surgical management for pyogenic liver abscess (PLA) has become the standard of care at most institutions with surgery relegated to salvage therapy for those who fail less invasive means. The aim of this study was to describe the outcomes of a step-up approach to PLA management. METHODS A retrospective chart review was conducted at a single institution for patients diagnosed with PLA over a 10-year period. Demographic, radiologic, microbiological, treatment, and outcomes data were collected and analyzed. RESULTS 64 patients with PLA were identified. Initial treatment included antibiotics alone (n = 9), percutaneous drainage (PD) (n = 54), and surgery (n = 1). Surgery was ultimately required in 8 patients while 50 were cured with PD and 4 with antibiotics alone. Two (3%) patients died. Overall, PD carried an 85% success rate. CONCLUSION PLA patients should be initially treated non-operatively, barring indications for emergent surgery or inaccessibility for PD. Surgery can be reserved for failure of PD.
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Affiliation(s)
- Kyle Rismiller
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John Haaga
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher Siegel
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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45
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Samadi K, Arellano RS. Drainage of Intra-abdominal Abscesses. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Yin JS, Govind S, Wiseman D, Inculet R, Kao R. Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report. J Med Case Rep 2017; 11:106. [PMID: 28403899 PMCID: PMC5390442 DOI: 10.1186/s13256-017-1270-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature. Case Presentation A 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved. Conclusions Refractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.
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Affiliation(s)
- Jun Sunny Yin
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Shaylan Govind
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Daniele Wiseman
- Department of Medical Imaging, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Raymond Kao
- Division of Critical Care, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada.
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Virgilio E, Mercantini P, Ferri M, Cavallini M. Pyogenic liver abscess: A very late and rare complication after pancreaticoduodenectomy. Microbiol Immunol 2017; 60:568-9. [PMID: 27443259 DOI: 10.1111/1348-0421.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Edoardo Virgilio
- Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology 'Sapienza', St. Andrea Hospital, via di Grottarossa 1035-39, Rome 00189, Italy
| | - Paolo Mercantini
- Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology 'Sapienza', St. Andrea Hospital, via di Grottarossa 1035-39, Rome 00189, Italy
| | - Mario Ferri
- Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology 'Sapienza', St. Andrea Hospital, via di Grottarossa 1035-39, Rome 00189, Italy
| | - Marco Cavallini
- Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology 'Sapienza', St. Andrea Hospital, via di Grottarossa 1035-39, Rome 00189, Italy
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48
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Akuzawa N, Hatori T, Kitahara Y, Kurabayashi M. Multiple liver abscesses and bacteremia caused by Streptococcus constellatus infection: a case report. Clin Case Rep 2016; 5:69-74. [PMID: 28096994 PMCID: PMC5224772 DOI: 10.1002/ccr3.774] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/20/2016] [Accepted: 11/23/2016] [Indexed: 12/16/2022] Open
Abstract
The Streptococcus milleri group (SMG) comprises commensal mucosal bacteria. Pyogenic liver abscesses due to hematogenous SMG infection are rare but can be observed even in healthy patients. In such cases, physicians should consider the existence of primary lesions that allow penetration of the SMG.
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Affiliation(s)
- Nobuhiro Akuzawa
- Department of General Medicine National Hospital Organization Shibukawa Medical Center 383 Shiroi Shibukawa Gunma 377-0280 Japan
| | - Takashi Hatori
- Department of Internal Medicine Japan Community Health Care Organization Gunma Chuo Hospital 1-7-13 Koun-cho Maebashi Gunma 371-0025 Japan
| | - Yonosuke Kitahara
- Department of Internal Medicine Japan Community Health Care Organization Gunma Chuo Hospital 1-7-13 Koun-cho Maebashi Gunma 371-0025 Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
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49
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Modern role of clinical ultrasound in liver abscess and echinococcosis. J Med Ultrason (2001) 2016; 44:239-245. [DOI: 10.1007/s10396-016-0765-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
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50
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Liu L, Chen W, Lu X, Zhang K, Zhu C. Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China. J Emerg Med 2016; 52:409-416. [PMID: 27765437 DOI: 10.1016/j.jemermed.2016.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed. RESULTS The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%). CONCLUSIONS Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome.
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Affiliation(s)
- Li Liu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wanjun Chen
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaoye Lu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Keji Zhang
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Changqing Zhu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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