Cause Of Liver Abscess Research Articles

Isolated Tubercular Liver Abscess: an entity rarely thought, diagnosed on cytology

INTRODUCTION: Tuberculosis is a rare cause of liver abscess in the Indian subcontinent even though the disease itself has high prevalance rates here. Isolated tubercular liver abscess presenting without any other foci of infection is a rare presentation with a documented prevalence of 0.34%. In an adult immune competent patient diagnosis can be challenging as it is likely to be confused with pyogenic and amoebic liver abscess or hepatoma. CASE HISTORY: A 30 year old female patient presented with complaints of low grade fever, vague abdominal pain of 4 months duration, breathlessness and loss of appetite for 1 month. Past or family history was non-contributory. Ultrasonography abdomen revealed a small hypoechoic lesion in sub-hepatic region of size 49x20mm suggestive of a liver abscess. Computerized Tomographic scan images confirmed loculated irregular collections in and around left lobe of liver and Reidel’s lobe. Fine needle aspiration cytology from the lesion revealed ill formed granulomas on a necrotic background. Zeihl Neelson staining was positive for acid fast bacilli CONCLUSION: Isolated tubercular liver abscess is a rare entity, particularly in immunocompetent individuals.Symptomatology and radiologic findings may not be contributory. Diagnosis of this entity rests on the demonstration of acid fast bacilli in material obtained. FNAC is a simple minimally invasive, cost effective procedure which helps attain the same. DOI: 10.21276/APALM.1382

Multiple Liver Abscesses due to Citrobacter koseri: An Extremely Rare Presentation

Pyogenic liver abscess (PLA) of the liver is relatively rare. Citrobacter is a very rare cause of liver abscess. We report a case of multiple liver abscess due to Citrobacter koseri. This is the 3rd reported case with liver abscess and Citrobacter koseri. A 61 years old woman presented to the ER with abdominal pain, fever, and progressive jaundice of 2 weeks duration. She had history of NHL which presented with biliary obstruction that required biliary stent placement 3 years back. The biliary sent was not removed as the patient was lost to follow up. She was hypotensive requiring IV fluid boluses and pressor support. Laboratory studies: white blood count 25.16 k/μL, serum creatinine 1.3 mg/dl, total bilirubin 2.5 (mg/dL), direct bilirubin 2.0 (mg/dL), alkaline phosphatase 345 (IU/L), ALT 57 (IU/L), and AST 152 (IU/L). U/S of the abdomen showed extensive intrahepatic biliary dilatation and multiple hypoechoic structure in the liver. CT of the abdomen showed lesions scattered throughout the liver suscpecious of abscesses. Blood culture was positive for Citrobacter koseri. Patient underwent liver biopsy with aspiration pus and three core biopsies. Citrobacter koseri was isolated from the pus. Pathology was negative for malignancy. The patient was treated with IV Imipenem and oral ciprofloxacin for 6 weeks and had remarkable clinical improvement. Follow up imaging studies with U/S showed complete resolution of the abscesses. Pyogenic Liver Abscesses due to Citrobacter koseri is a rare infection; we are aware of only two reported cases in the literature. Therefore, little is known about Citrobacter liver abscess in terms of incidence, associated underlying diseases, and outcome. Treatment of citrobacter koseri infection in general could be complicated by rapid development of resistance particularly if monotherapy with a cephalosporin is started. This is mainly due to due to high level of beta lactamase and cephalosporinase production. Thus, combination therapy is recommended for initial empirical treatment of Citrobacter koseri infection.

Fusobacterial liver abscess: a case report and review of the literature

BackgroundFusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature.Case presentationA 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment.A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords “Fusobacterium” and “Liver abscess”. Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search.Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre’s Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks.ConclusionFusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.

A Case Series of Liver Abscess Formation after Transcatheter Arterial Chemoembolization for Hepatic Tumors.

Background:Liver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches.Methods:From June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records.Results:These five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures.Conclusions:TACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

BackgroundSince 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial.MethodsAll clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson’s medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced.ResultsFrom July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results.ConclusionTo our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

Cases of liver abscess complicated by portal vein thrombosis are relatively rare. We report a case of liver abscess caused by α-hemolytic streptococci and complicated by portal vein thrombosis. A 51-year-old male presented with fever and right hypochondralgia. He had watery diarrhoea and bloody stool for over 1 month before presentation. Laboratory tests showed elevated hepatobiliary enzymes, inflammation findings, and anemia. Abdominal imaging revealed liver abscess in the right lobe and thrombosis of right and left branches of the portal vein; no thrombosis was observed in the extrahepatic portal vein. Colonoscopy revealed nonspecific colitis without diverticula or malignancies, and no possible causes of liver abscess except for enterocolitis were detected. Clinical course and laboratory findings indicated that an amoebic liver abscess was unlikely. Blood and pus cultures were positive for α-hemolytic streptococci. A diagnosis of liver abscess caused by α-hemolytic streptococci and complicated by portal vein thrombosis was made. The size of the liver abscess reduced, and inflammation findings resolved with 3 weeks of antibiotic treatment and abscess drainage. Portal vein thrombosis disappeared after 2 week anticoagulant therapy.

Nocardia Liver Abscess – An Uncommon Infection Post Liver Transplant

Background: Nocardiosis is a rare, localised or disseminated, bacterial infection caused by aerobic actinomyces. It commonly affects immunocompromised hosts. With increasing load of post transplant patients the world over, this infection has been reported with increasing frequency.Case Report: A 59-year-old gentleman underwent living donor liver transplant for ethanol related ESLD in our hospital. Immediate post OP period was uneventful. After 6 weeks post transplant he presented with abdominal pain and low grade fever. General examination was unremarkable except for minimal tenderness over right hypochondrium. His baseline laboratory evaluation revealed hemoglobin 8.7 gm%, leukocyte count 7170/cumm, platelets 176,000/cmm. Liver function revealed total bilirubin 0.46 mg/dL, AST 14 μ/L, ALT 25 μ/L, albumin 2.6 g/L, alkaline phosphatase 74 μ/L, GGT 78 μ/L and INR 1.2. Tacrolimus level 6 mg/dL. Ultrasound abdomen revealed well-defined thin walled hypoechoic lesion in segment VII measuring 53 mm × 58 mm liver abscess. CT scan of abdomen showed a 6.2 cm × 6 cm × 5.9 cm size multiloculated hypodense collection in segment VII of right lobe with perilesional edema. He underwent percutaneous drainage of collection, which revealed purulent aspirate. Microbiological examination of aspirates showed pus cells and occasional gram-positive branching filaments. Modified acid-fast stain was positive. Culture revealed Nocardai spp. MALDI-TOF test was positive for Nocardia farcinica. He was treated with trimethoprime-sulfamethoxazole, amikacin and imipenem for 2 weeks. He was kept on low immunosuppression. His fever subsided over next few days. Repeat ultrasound scan revealed collapsed abscess cavity with small remnant collection. He was discharged on oral antimicrobials and is under regular follow up.Conclusion: Nocardiosis should be suspected as a likely cause of liver abscess in the setting of immunocompromised patients. Long-term treatment with trimethoprime-sulfamethoxazole for up to 6 months improves survival.Conflicts of InterestThe authors have none to declare. Background: Nocardiosis is a rare, localised or disseminated, bacterial infection caused by aerobic actinomyces. It commonly affects immunocompromised hosts. With increasing load of post transplant patients the world over, this infection has been reported with increasing frequency. Case Report: A 59-year-old gentleman underwent living donor liver transplant for ethanol related ESLD in our hospital. Immediate post OP period was uneventful. After 6 weeks post transplant he presented with abdominal pain and low grade fever. General examination was unremarkable except for minimal tenderness over right hypochondrium. His baseline laboratory evaluation revealed hemoglobin 8.7 gm%, leukocyte count 7170/cumm, platelets 176,000/cmm. Liver function revealed total bilirubin 0.46 mg/dL, AST 14 μ/L, ALT 25 μ/L, albumin 2.6 g/L, alkaline phosphatase 74 μ/L, GGT 78 μ/L and INR 1.2. Tacrolimus level 6 mg/dL. Ultrasound abdomen revealed well-defined thin walled hypoechoic lesion in segment VII measuring 53 mm × 58 mm liver abscess. CT scan of abdomen showed a 6.2 cm × 6 cm × 5.9 cm size multiloculated hypodense collection in segment VII of right lobe with perilesional edema. He underwent percutaneous drainage of collection, which revealed purulent aspirate. Microbiological examination of aspirates showed pus cells and occasional gram-positive branching filaments. Modified acid-fast stain was positive. Culture revealed Nocardai spp. MALDI-TOF test was positive for Nocardia farcinica. He was treated with trimethoprime-sulfamethoxazole, amikacin and imipenem for 2 weeks. He was kept on low immunosuppression. His fever subsided over next few days. Repeat ultrasound scan revealed collapsed abscess cavity with small remnant collection. He was discharged on oral antimicrobials and is under regular follow up. Conclusion: Nocardiosis should be suspected as a likely cause of liver abscess in the setting of immunocompromised patients. Long-term treatment with trimethoprime-sulfamethoxazole for up to 6 months improves survival. Conflicts of InterestThe authors have none to declare. The authors have none to declare.

Cholecystocolonic Fistulas from Diverticulosis: A Potentially Missable Cause of Liver Abscesses

Cholecystocolonic fistulas (CCF) due to colonic diverticulosis are a rare cause of liver abscesses. It is even rarer to simultaneously have choledocholithiasis, another cause for liver abscesses. In this case report, we found both pathologies and emphasise the need to study cholangiograms carefully so as not to miss alternative diagnoses.

The Prevalence of Colonic Neoplasm in Cryptogenic Pyogenic Liver Abscess: A Prospectively Enrolled Cross-sectional Study.

Several studies suggest that pyogenic liver abscess (PLA) is associated with colon neoplasm. A colonoscopic exam for cryptogenic PLA might detect a hidden colon neoplasm, through which intestinal flora can be transmitted into the liver. However, there are no prospectively enrolled cross-sectional data for colonic neoplasm in cryptogenic PLA. Patients with PLA were prospectively enrolled from two university hospitals. Among them, all the patients with cryptogenic PLA were recommended for colonoscopic exam to check for colonic neoplasm. One hundred eighty-three patients with PLA were enrolled in the study for 22 months. One hundred and one (55.2%) patients did not have a definite cause of liver abscess at initial evaluation. The median diameter of the largest lesion was 5.7 cm (1.0-14.0 cm), and 74.3% of the patients were treated by percutaneous abscess drainage. Ninety-one percent of the patients who had an identified pathogen yielded Klebsiella. Sixty-two patients underwent colonoscopic exams, and no one had a colonic cancer, one had an adenomatous polyp with high grade dysplasia (1.6%), and 27 had adenomatous polyps with low grade dysplasia (43.5%; 41.0% in male and 43.5% in female). Of fifty patients who underwent an esophagogastroduodenoscopic exam, nine had gastric ulcers, one had an esophageal ulcer, and one had hemorrhagic gastritis. The prevalence of colonic neoplasm among the patients with cryptogenic PLA was not as high as that in previous studies. Further well-designed, large-scale studies are required to assess the association of the colon neoplasm and cryptogenic PLA.

Klebsiella pneumoniaeLiver Abscess and Metastatic Endophthalmitis

Introduction. Klebsiella pneumoniae is a well-known cause of liver abscess. Higher rates of liver abscess associated with Klebsiella pneumoniae are seen in Taiwan. Metastatic endophthalmitis is a common complication associated with a poor prognosis despite aggressive therapy. Case Report. We report a case of a 67-year-old Korean female with Klebsiella pneumoniae liver abscess. The patient developed metastatic endophthalmitis and ultimately succumbed to her disease despite aggressive medical and surgical treatment. Conclusion. Dissemination of Klebsiella pneumoniae is associated with significant morbidity and mortality. Liver abscesses preferably should be treated with percutaneous drainage, but surgical treatment is needed in some cases. Metastatic spread to the eye is a common complication that must be treated aggressively with intravenous antibiotics and surgical intervention if necessary.

Clinical Pattern of Liver Abscess among the Patients Admitted in Rajshahi Medical College Hospital

Introduction: Liver abscess is an important clinical problem in tropical regions of the world. Current assessment of liver abscesses should allow for better understanding of the aetiopathogenesis of the disease. This study was conducted to find the clinical pattern and aetiopathogenesis of liver abscess in patients admitted in Rajshahi Medical College Hospital.Methodology: The present cross-sectional study was carried out in the Department of Medicine, Rajshahi Medical College Hospital (RMCH) on consecutive 34 patients of liver abscess admitted between the period of July 2002 and June 2003. Detailed history and clinical examination were performed in all patients. All routine investigations were done. Liver abscess was confirmed by ultrasonography (USG). Aspiration of liver abscess was done under sonographic guidance in the Nuclear Medicine Department of RMCH to diagnose the cause of liver abscess. Aspirated materials were sent for microscopical examination and culture and sensitivity in the Department of Microbiology of the same Institute.Result: The findings showed that early middle-aged population were usually affected by liver abscess followed by middle aged (mean age around 40 years). The patients were predominantly male with males being 16 times more likely to suffer from the disease than the females. Most of the patients belong to low socioeconomic status (82.4%). All patients had fever and malaise. Other common manifestations were loss of appetite, lump in the abdomen, intercostal tenderness, nausea/ vomiting, loss of weight. Less common presentations were diarrhoea (29.4%), jaundice (23.5%), cough (11.8%), chest pain (11.8%) and breathlessness (2.9%). Liver span of the patients measured by ultra-sonogram showed hepatomegaly in all cases. All patients with pyogenic liver abscess and 75% of the patients with amoebic abscess had the history of prolonged intake of fermented palm juice (palm wine). Microscopic examination of the pus/aspirate drawn from the liver revealed trophozoite in 7(20.6%) cases. However, on culture of the specimen, 12(35.3%) were culture positive and 22(64.7%) were culture negative.Conclusion: Middle-aged male with low socioeconomic status with the history of prolonged palm wine intake are the most common characteristic of patients with liver abscess. Multi-center study with large sample size is recommended to verify the findings of the present study.Bangladesh J Medicine Jul 2015; 26 (2) : 55-60

A Rare Case of Fusobacterium nucleatum Liver Abscess in Immunocompetent Patient

Fusobacterium nucleatum is an oropharyngeal bacteria which is associated with periodontal disease. Previous reports have described pyogenic liver abscesses due to Fusobacterium nucleatum in immunocompromised adults. However, its role as an etiological agent in liver abscesses in immunocompetent adults is poorly understood and to date, there are no case reports of Fusobacterium Nucleatum liver abscesses in the setting of liver cysts. We present a case of a fusobacterium liver abscess in an immunocompetent male in the setting of liver cysts. 51 year old male with a history of hypertension was in his usual state of health when he developed fever, chills associated with diarrhea and right-sided abdominal pain. The patient was diagnosed with infectious colitis. He was treated with Flagyl for 10 days. CT scan performed showed evidence of colitis and there were 2 liver cysts noted incidentally. The patient subsequently had a colonoscopy, which did not reveal any evidence of colitis and patient improved. However, 2 months later, pt returned with RUQ abdominal pain, and CT showed interval worsening of the size of the cysts with connection to a large 10 cm liver abscess in the right lobe of the liver. Patient did not have any history of periodontal disease. Laboratory data demonstrated borderline leukocytosis (WBC 11.9) and Tbili, AST, ALT within normal limits. Blood cultures remained negative. The patient was admitted to the hospital and had a CT-guided abscess drainage performed with drainage of about 200 ml of thick pus. Gram stain showed Gram-negative rods and grew Fusobacterium nucleatum. Patient was discharged on PO antibiotics following drainage and subsequent CT showed complete resolution of liver abscesses. This is a rare case of Fusobacterium nucleatum causing a liver abscess and notably, seemed to infect liver cysts that were asymptomatic prior to patient presentation. Patient did not have a history or oropharyngeal disease and had no tests that revealed an immunocompromised state. This case study suggests that Fusobacterium nucleatum should be considered in immunocompetent patients as a cause of liver abscess.

Abcessos Hepáticos Múltiplos devido a Morganella morganii

Keywords: Liver Abscess; Morganella morganii.

TUBERCULOUS LIVER ABSCESS WITH RIGHT SIDED PLEURAL EFFUSION

Tuberculosis is a rare cause of liver abscess even in countries where the tuberculosis is prevalent, liver may be involved as a part of miliary tuberculosis or as local tuberculosis. We present a case of tuberculous liver abscess in patient with smear positive pulmonary tuberculosis and right pleural effusion. A positive BACTEC culture and Polymerase chain reaction (PCR) for Acid Fast Bacilli (AFB) in the pus aspirated from abscess confirmed the diagnosis of tuberculous liver abscess. Keywords: Liver Abscess, Pleural Effusion, Tuberculosis

Achromobacter xylosoxidans: A Rare Infection Masquerading as Metastatic Hepatic Malignancy

Introduction: The incidence of pyogenic liver abscesses is estimated to be 3.6 per 100,000 in the United States. Achromobacter xylosoxidans (AX) is an aerobic, motile, gram-negative bacillus, often misidentified as Pseudomonas aeruginosa, that can be isolated in hospital and domestic sink drains. Bacteremia and bronchiolitis due to AX has been described in patients after liver transplantation for Caroli’s disease and cystic fibrosis, respectively. Although it may be found occasionally in the bile, it is very rarely the cause of liver abscess in immunocompetent patients. Rare cases of liver and intraabdominal abscesses caused by AX have been described in association with prior cholecystectomy. We describe a rare case of AX infection mimicking hepatic malignancy in an immunocompetent patient after cholecystectomy and ERCP. A 66-year-old female with history of open cholecystectomy for gangrenous cholecystitis, ERCP for gallstone pancreatitis, PPD+, and recent colonoscopy with polypectomy, was admitted for right upper quadrant abdominal pain, nausea, and weight loss. Laboratory work-up showed WBC count of 13 with 77% neutrophils, platelets 575, total bilirubin of 1.4 mg/dL, and alkaline phosphatase 255 U/L. CT of the abdomen revealed 2 solid masses in the liver. CEA, CA 19-9, AFP, and CA-125 were normal. CT of chest showed only emphysematous changes. Two needle liver biopsies showed fibroinflammatory tissue with focal necrotizing granulomas, and large droplet steatosis, compatible with an infectious process suggestive of AX. The patient was treated with sulfamethoxazole/trimethoprim 800/160 mg, and within 2 weeks, she demonstrated significant improvement in appetite and weight gain. After 6 weeks of therapy, she was asymptomatic with complete resolution of the lesions on repeat MRI. While AX is a ubiquitous waterborne nosocomial organism, it rarely causes infections in immunocompetent hosts. Hepatic involvement may mimic metastatic malignancy and may pose additional diagnostic challenges. It is important to be cognizant of this rare cause of liver abscess in immunocompromized and immunocompetent patients after cholecystectomy and ERCP.

Hypermucoviscous Klebsiella syndrome without liver abscess in a patient with immunoglobulin g2 immune deficiency.

Background Hypermucoviscous Klebsiella pneumoniae (HMVKP) emerged as a cause of invasive infections in South-East (SE) Asia. It has become the most common cause of liver abscess in that region, and it is a significant causative organism in endogenous endophthalmitis and meningitis. During the past decade, cases of this uniquely virulent organism have been reported outside of SE Asia, with a propensity to affect individuals of SE Asian descent. Cases have been reported from North America including Canada.Methods We report a case of a patient of Filipino descent living in Canada who presented with recurrent HMVKP bacteremia in the absence of pyogenic liver abscess or other localized metastatic Klebsiella infection.Results Investigations identified an immunoglobulin (Ig)G2 deficiency and low IgM indicating potential common variable immunodeficiency, and administration of intravenous immunoglobulins was associated with prevention of further recurrences.Conclusions To our knowledge, this is the first report of HMVKP associated with predisposing antibody deficiency.

Pyogenic liver abscess and the emergence of Klebsiella as an etiology: a retrospective study

ObjectivesPyogenic liver abscess (PLA) is a significant, though uncommon, cause of morbidity in the United States. Recently, Klebsiella has emerged as an important cause of PLA. We analyzed the clinical course, microbiology, and treatment outcomes of patients discharged with PLA. In addition, we sought to examine the incidence of and risk factors for Klebsiella liver abscess (KLA).MethodsWe reviewed the charts of patients who discharged with PLA from two teaching hospitals in West Texas between January 1, 2007 and December 31, 2011.ResultsWe identified 49 cases of PLA. Abscess cultures were positive in 23 (48%) patients. The mean age of the cohort was 56 years (range: 20–83 years). Sixty percent were male. The most frequent conditions associated with PLA were intra-abdominal infections (ten cases; 20%), diabetes mellitus (nine cases; 18%) and malignancy (nine cases; 18%). Klebsiella was the most commonly isolated species from the abscess cultures (seven cases; 30% of all positive abscess cultures). We used univariate and logistic regression analyses to identify the risk factors for KLA. Controlling for age, only malignancy was identified in our cohort as a risk factor for a Klebsiella liver abscess. The overall mortality was 2%.ConclusionKlebsiella is emerging as an important cause of liver abscesses. Malignancy may be an important risk factor for Klebsiella liver abscess.

Visceral larva migrans presenting as multiple liver abscesses

Eosinophilic necrotizing granulomas in the liver, known as visceral larva migrans (VLM), are a rare cause of liver abscesses. The term VLM refers to infections in human tissues caused by the larval stages of ascarid worms of dogs and cats. We report two cases of VLM which presented with high grade fever and abdominal pain for 3-4 months. Marked peripheral eosinophilia, multiple confluent perivenous lesions in the right lobe of liver with characteristic migratory tracts on imaging and biopsy evidence of necrotizing eosinophilic granulomas led to the diagnosis. Complete recovery was achieved with repeated courses of a combination of anthelmintics.

Klebsiella pneumoniae liver abscesses

Klebsiella pneumoniae liver abscesses

Standardized outpatient management of Klebsiella pneumoniae liver abscesses

Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment. We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality. All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02). The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.