Abstract
BackgroundWe describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality.MethodsRetrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years.ResultsOne 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%.ConclusionsClinical 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.
Highlights
We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality
Characteristics of PLA and ALA patients We identified 132 pyogenic liver abscess (PLA) and 9 amoebic liver abscess (ALA) admissions during the period May 2008 to June 2017 (Table 1)
In our cohort of patients with liver abscess we found no large differences in clinical parameters between pyogenic liver abscess (PLA) and amoebic liver abscess (ALA), other than weak evidence of higher baseline C-Reactive Protein (CRP) for ALA compared with PLA
Summary
We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. The incidence of liver abscess, a rare but potentially lifethreatening infection, appears to be increasing worldwide [1,2,3,4]. A wide variety of bacteria have been described as causes of pyogenic liver abscess (PLA), but published data on associations of bacterial species with clinical presentation, radiological findings and prognosis are sparse. A protozoan parasite, is a well-recognized non-bacterial cause of liver abscess. In Europe, cases of amoebic liver abscess (ALA) are rare and usually imported, whereas in some highly endemic areas ALA can be more common than PLA [7]. There is limited evidence as to how PLA and ALA can be distinguished clinically or radiologically
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