Cause Of Liver Abscess Research Articles

Loop-mediated isothermal amplification (LAMP) assay for rapid detection of Entamoeba histolytica in amoebic liver abscess

Amoebic liver abscess (ALA) is the most common extra intestinal manifestation of invasive amoebiasis caused by Entamoeba histolytica. The lack of early and accurate diagnostic test to differentiate various causes of liver abscess necessitates more reliable laboratory diagnostic test. The present study was conducted to assess the applicability of Loop-Mediated Isothermal Amplification (LAMP) assay for detection of E. histolytica in ALA cases. Fifty patients (n = 50) with clinical suspicion of ALA were enrolled in the study. All the clinical samples were subjected to conventional PCR assay. LAMP assay was standardized and the results were compared with that of PCR assay. Out of fifty pus samples thirty-six (72 %, 36/50) were positive for E. histolytica with conventional PCR assay and forty-one (82 %, 41/50) were positive by LAMP assay. Thus, five additional positive cases, missed by conventional PCR were positive with LAMP assay. Apart from rapidity, operational simplicity of LAMP assay high specificity and sensitivity, one-step amplification, higher yield and immediate visual detection may serve as a better diagnostic tool for diagnosis of ALA.

Pyogenic Liver Abscess Due to Fusobacterium Mimicking Metastatic Liver Malignancy

Introduction: Pyogenic liver abscess accounts for 80% of hepatic abscess cases in the United States. Increasing rates of anaerobic involvement has been reported since 1974. Fusobacterium species are among the most commonly encountered anaerobes, although it is a rare finding to see Fusobacterium species as a cause of liver abscess. Case Presentation: A 60-year-old man with a history of 100 pack year of tobacco use and chronic obstructive pulmonary disease, presented with radiological findings for metastatic liver malignancy. This was an incidental finding when the patient had a computed tomographic pulmonary angiogram to rule out pulmonary embolism. The incidental findings were followed up with radiological testing, a colonoscopy, endoscopy, and 2 biopsies. The patient’s condition was finally diagnosed as a liver abscess due to Fusobacterium and was successfully treated with a prolonged course of metronidazole. Conclusion: Pyogenic liver abscess can mimic metastatic malignancy and should be considered when multiple hepatic lesions are seen on an abdominal computed tomography or other compatible diagnostic imaging.

Should colonoscopy be performed in patients with cryptogenic liver abscess?

The interruption of a mucosal barrier by colon cancer or a polyp can lead to the development of a liver abscess. This study aimed to evaluate the possible contribution of colon cancer to the development of liver abscess and the necessity of colonoscopy in patients presenting with cryptogenic liver abscess. We reviewed the medical records of 268 patients diagnosed with liver abscess between January 2001 and April 2010. Among cases with no definite cause of liver abscess, differences between patients with and without colon cancer were evaluated in terms of clinical, laboratory, imaging, and microbiological findings. Pyogenic liver abscess with no apparent etiology was encountered 163 patients; colonoscopy was performed in 121 of these 163 patients. The tumor diagnosis was confirmed by total colonoscopy in 12/163 (7.4%) patients with adenocarcinoma and 8/163 (4.9%) patients with high-grade dysplasia. Nine patients were diagnosed with stage I, two patients with stage II, and one with stage III disease according to the tumor, nodes, and metastases (TNM) staging system for colorectal cancer. The prevalence of incidental colon cancer in patients with pyogenic liver abscess was significantly higher than that of normal individuals who underwent colonoscopy (0.8%, 90/11,272) at our health care center. Colon cancer may be one etiology of liver abscess. Colonoscopy should be considered in patients with pyogenic liver abscess with not an apparent primary source of infection.

Study on capsular serotype of Klebsiella pneumoniae from patients with liver abscesses and its clinical characteristics

Primary pyogenic liver abscess caused by Klebsiella pneumoniae has recently become an emerging disease, which is often complicated by septic meningitis and endophthalmitis. K. pneumoniae is a significant cause of liver abscess. The invasive K. pneumoniae infections can attack healthy individuals, and some of its patient has a predisposing condition such as diabetes mellitus. According to these capsular polysaccharides, K. pneumoniae can be classified into 77 serological K antigen types. To date, K serotype distribution of K. pneumoniae causing liver abscess is little known in Northeast of China. In our study, we performed polymerase chain reaction (PCR)-based genotyping to identify capsular serotypes, and present the current epidemiologic status ofK. pneumoniae liver abscess in local area. Among the K. pneumoniae from 35 patients with liver abscess, we found 20 (57.1%) isolates of K1 serotype. Clinical characteristics [such as, age, sex, diabetes mellitus, Liver and biliary disease history, extended-spectrum β-lactamases (ESBLs) producing and etc.] of patients with liver abscess of K. pneumoniae belonging to K1 or non-K1 serotype were also analyzed, but no significant difference was found. There are only three isolates of K. pneumoniae with ESBLs. In conclusion, K. pneumoniae K1 serotype is the major serotype causing liver abscess in local region. Key words: Capsular serotype, liver abscess, Klebsiella pneumonia

Foreign Body-Induced Liver Abscess: Is Surgery Indispensable?

A case of hepatic abscess that developed secondary to a foreign body migration is reported herein. In most published cases, the diagnosis is done after failure of medical treatment or recurrence of the abscess. CT-scan findings may lead to an early diagnosis, like in this case. The patient was treated by percutaneous abscess drainage and adapted antibiotherapy. Because of remarkable co-morbid conditions, no removal surgery was performed. No recurrence of the abscess could be observed after eighteen months of follow up. Foreign body is a rare cause of liver abscess that may not be ignored by clinicians. Although removal surgery is the mainstay of its treatment, a medical approach could be attempted with efficacy.

A Case of Giant Hepatic Hydatid Cyst Infected withMorganella morganiiand the Literature Review

Hydatid cyst disease is a common worldwide zoonosis. Most of the cysts are located in the liver. Abscess formation due to infection of the cyst is an important complication. M. morganii, a Gram-negative Bacillus, is a quite rare cause of liver abscess. A 77-year-old woman was admitted to hospital with complaints of fever, chills, nausea, vomiting, loss of appetite, and abdominal pain located in the right-upper quadrant. Her history was positive for hepatic hydatid cyst disease ten years ago. Physical examination revealed a painful mass filling the right-upper quadrant and extending down to umbilicus. Indirect hemagglutinin test for hydatid cyst was positive at a titer of 1/320. Giant liver abscess due to infected hydatid cyst was found in computed tomography scan. Surgeons performed cystectomy and cholecystectomy. Cefazoline, cefuroxime, and metronidazole were administered empirically, but all the three agents were replaced with intravenous ceftriaxone after M. morganii was isolated from the cultures of the abscess material. Clinical signs of the patient resolved at the second week of treatment, and she was discharged.

Clinical and bacteriological characteristics of Klebsiella pneumoniae causing liver abscess with less frequently observed multi-locus sequences type, ST163, from Singapore and Missouri, US

Klebsiella pneumoniae is the major cause of liver abscesses in several Asian countries. Differences in the type of circulating Klebsiella strains and/or the genetic make up of the host seem to be plausible explanations for this. Two recent K. pneumoniae strains isolated from patients with liver abscess, one from Missouri in the US, and a second one from Singapore, were fully characterized by molecular typing, association of virulent genes, neutrophil phagocytosis, susceptibility to serum killing, and lethality in mice. Both strains had mucoid colony morphology and were similar in multilocus sequence type (ST-163), drug-susceptibility profile, resistance to phagocytosis and susceptibility to serum killing. Although ST-163 is a single nucleotide variant (SNV) to the major ST-23, which is specific to serotype K1 K. pneumoniae that causes liver abscess in Taiwan, these two isolates differ in capsular serotype. One was serotype K1 and the other K29. Since a serotype K35 with ST163 was reported previously to cause peritonitis, serotype K29 with SNV to ST-23 was not impossible. Pulsed field gel electrophoresis by XbaI digestion showed different restriction patterns. The virulence-associated genes rmpA and aerobactin were only present in the serotype K1 isolate from Singapore and not in the serotype K29 isolate from Missouri. The serotype K1 isolate was also more virulent to mice. The reasons underlying the high prevalence of ST-23 or its SNV in K. pueumonaie liver abscesses is worth further investigation.

Foreign bodies as infrequent cause of liver abscess

Foreign bodies as infrequent cause of liver abscess

A Case of Liver Abscess Caused byFusobacterium nucleatumin a Patient with Recurrent Periodontal Diseases

Fusobacteria are anaerobic gram-negative, non-spore forming bacilli found in normal flora of the oral cavity, urogenital tract, and gastrointestinal tract. Fusobacterium nucleatum has been seldom reported as a cause of liver abscess, particularly in immunocompetent hosts. A 55-year-old man with frequent periodontal disease visited our hospital with intermittent fever and headache for 2 months. Abdominal CT scan revealed an 8.2 × 6 cm mass in the right hepatic lobe with central low density. Abscess culture revealed F. nucleatum as the causative organism. Percutaneous abscess drainage and intravenous administration of antibiotics for 4 weeks improved symptoms and decreased the abscess size. We report a rare case of liver abscess due to F. nucleatum in an immunocompetent man with periodontal disease.

Do Neutrophils Play a Role in Establishing Liver Abscesses and Distant Metastases Caused by Klebsiella pneumoniae?

Serotype K1 Klebsiella pneumoniae is a major cause of liver abscesses and endophthalmitis. This study was designed to identify the role of neutrophils in the development of distant metastatic complications that were caused by serotype K1 K. pneumoniae. An in vitro cellular model was used to assess serum resistance and neutrophil-mediated killing. BALB/c mice were injected with neutrophils containing phagocytosed K. pneumoniae. Serotype K1 K. pneumoniae was significantly more resistant to serum killing, neutrophil-mediated phagocytosis and intra-cellular killing than non-K1 isolates (p<0.01). Electron microscopic examination had similar findings as in the bioassay findings. Intraperitoneal injection of neutrophils containing phagocytosed serotype K1 K. pneumoniae led to abscess formation in multiple sites including the subcutaneous tissue, lung, and liver, whereas no abscess formation was observed in mice injected with non-K1 isolates. The resistance of serotype K1 K. pneumoniae to complement- and neutrophil-mediated intracellular killing results in the dissemination of K. pneumoniae via the bloodstream. Escape from neutrophil intracellular killing may contribute to the dissemination and establishment of distant metastases. Thus, neutrophils play a role as a vehicle for helping K. pneumoniae and contributing to the establishment of liver abscess and distant metastatic complications.

Pyogenic liver abscess: Changing patterns in approach

To define optimum management of the pyogenic liver abscess and assess new trends in treatment. One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir (India) from July 2001 to August 2006 were studied to evaluate and define the optimum treatment. Mortality in the surgically treated group of patients was 9.4% (12/119), while those treated non-surgically had a fatality rate of 16.66% (7/42). Multiple liver abscesses treated surgically had a surprisingly low mortality of 30%. The biliary tract (64.97%) was the most common cause of liver abscess. Multiple abscesses, mixed organisms and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor in determining survival. Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.

An unusual cause of liver abscess

An unusual cause of liver abscess

Hepatobiliary and Pancreatic: Liver abscess caused by an ingested foreign body

Pyogenic liver abscesses continue to be a significant cause of morbidity and mortality. The most common predisposing factor is cholangitis. This is usually associated with bile duct stones or with endoscopic, percutaneous or operative procedures that involve the use of tubes or stents within the biliary system. Cholangitis is also likely to account for occasional patients who develop a liver abscess after endoscopic sphincterotomy or biliary-intestinal anastomoses such as choledochoduodenostomy. Another cause for liver abscesses is portal bacteremia associated with inflammatory disorders of the abdomen such as appendicitis and diverticulitis. Abscesses can also develop in the apparent absence of biliary or gastrointestinal infections but are presumably related to bacteremia. Rare causes of liver abscess include liver neoplasms that undergo necrosis after radiofrequency ablation or chemoembolization. Another rare cause is illustrated by the following report. The patient was a teenager, aged 17, who was admitted to hospital with fever and rigors for 10 days. She also had pain in the upper abdomen and lower chest that was aggravated by inspiration and lying on her right side. Additional symptoms included anorexia, nausea and vomiting with one episode of hematemesis. Her temperature ranged from 100–103°F (37.8–39.4°C) and she had tender hepatomegaly and intercostal tenderness. Blood tests revealed anemia (80 g/l), an elevated white cell count (16.5 × 109/l), a mild elevation of bilirubin and alanine aminotransferase and a moderate elevation of alkaline phosphatase (420 U/L). An ultrasound study revealed a complex space-occupying lesion in the liver. The computed tomography (CT) scout image showed two linear shadows, probably metal, in the right abdomen (Figure 1). In Figure 2, a contrast-enhanced CT scan showed a septated abscess cavity, 11 cm in diameter, in the right lobe of the liver with air loculations. A needle, 8 cm in length, traversed the abscess cavity. The patient was treated by surgical drainage of the liver abscess and removal of both sewing needles. There were no post-operative complications and she was in good health on follow-up after 3 months. On more detailed questioning, she volunteered that she had accidentally ingested two sewing needles approximately 9 months prior to admission. In this case, the needles migrated into the liver through the stomach or duodenum and one needle subsequently resulted in a liver abscess.

Occult Colon Cancer in a Patient with Diabetes and Recurrent Klebsiella Pneumoniae Liver Abscess

Klebsiella pneumoniae (Kp) is a well-known leading cause of liver abscess in patients with diabetes, but recurrent Kp liver abscess in such patients within a period of time is seldom seen. Here, we report a patient with diabetes who experienced three episodes of Kp liver abscess within 1 year. The patient was subsequently diagnosed to have an occult sigmoid cancer. The liver abscess did not recur after resection of the colonic tumor. Occult sigmoid colonic cancer may have played an important role in the recurrent Kp liver abscess in our case. Therefore, further investigation of gastrointestinal malignancies, particularly of the colonic tract, is necessary in patients with diabetes and Kp liver abscess.

A clinical survey ofKlebsiella pneumoniae virulence and genotype in pyogenic liver abscess

Primary Klebsiella pneumoniae liver abscess with metastatic complications is a globally emerging infectious disease and is the leading cause of liver abscess in Taiwan. Host immunity and bacterial virulence, especially of the capsular polysaccharide type, are important in determining clinical manifestations. Investigators retrospectively studied the K pneumoniae genotype and capsular serotype from patients with 37 strains of liver abscess; no correlation was noted with genotype, and many genetically different strains caused liver abscess. Although K pneumoniae is prevalent in patients with diabetes, it can attack healthy or alcoholic people as well. Additional studies are needed to explore the mechanisms of bacterial virulence and to optimize treatment strategies. Physicians should be alert to the illness and its complications.

Pyogenic liver abscess caused by hypermucoviscous Klebsiella pneumoniae

Community-acquired primary pyogenic liver abscess (PLA) caused by Klebsiella pneumoniae is an emerging infectious entity, with cases reported in the scientific literature over the past 15 y mainly from Taiwan and Asia, but also from Europe and North America. We describe a case of PLA caused by the hypermucoviscous, K1 capsular serotype of Klebsiella pneumoniae in a Canadian man and highlight the unique features of this increasingly common cause of liver abscess.

Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation

Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. Because it is a rare entity, the treatment modality has not been fully established. We report for the first time a patient with an intrahepatic abscess due to gallbladder perforation successfully treated by endoscopic stent placement into the gallbladder who had a poor response to continuous percutaneous drainage.

Intrauterine Device Related Hepatic Abscess

Hepatic Actinomycosis is a rare, but well documented cause of liver abscess. Recent literature has demonstrated the relationship of intrauterine devices (IUD) and infection with Actinomycoses. Infections caused by Capnocytophaga species occur infrequently but usually present in patients that are immunocompromised. A 42 year old Polish female with no significant past medical history, presented with a month of upper abdominal fullness, loss of appetite, nausea, and weight loss of 30 lbs. On exam she was cachectic with right upper quadrant tenderness and hepatomegaly. Lab values were notable for WBC's of 12.1 with 27% bands, an alkaline phosphatase of 493 U/L, AST of 48 U/L, ALT of 45 U/L and albumin of 2.5 g/dL. A CT of the abdomen showed dilatation of the intrahepatic ducts, 2 large subcapsular fluid collections in the right lobe of the liver, a large fluid collection in the pelvis and the presence of an IUD. An ERCP demonstrated multiple saccular dilatations of the intrahepatic ducts and two cystic areas in the liver communicating with the biliary tree. Papillotomy was performed with drainage of purulent fluid. The patient underwent CT-guided drainage of the fluid collections in the right lobe of the liver and the pelvis, with removal of 700 ml of pus. The patient was started on piperacillin/tazobactam and the IUD was removed. The patient improved and cultures of the hepatic abscess eventually grew A. israelii and C. ochracea and the pelvic abscess grew A. israelii also. However the patient had a seizure 7 days into antibiotic therapy and CT of the head revealed 3 ring-enhancing lesions, consistent with metastatic abscesses. The patient was started on phenytoin and the antibiotics changed to ceftriaxone and metronidazole. Repeat CT of the abdomen showed resolution of the abscesses. The patient subsequently did well and eventually went home on long-term antibiotic therapy. Actinomyces and Capnocytophaga species are both endogenous to the oral flora and occasionally can be found in the gastrointestinal and vaginal tracts. Hepatic Actinomycosis accounts for 5% of all infections with Actinomyces species. Risk factors include poor dentition, appendicitis, prior abdominal surgery, immunosuppression and IUD use. Most infections with Capnocytophaga occur in immunocompromised patients with poor dentition and clinically manifest as bacteremia, endocarditis, osteomyelitis or empyema. An extensive literature review revealed only one case report of liver abscess due to Capnocytophaga.

A novel bacterium Achromobacter xylosoxidans as a cause of liver abscess: Three case reports

Achromobacter xylosoxidans is a microorganism that may cause opportunistic infections. We detected A. xylosoxidans in three of 46 patients with liver abscess. The clinicopathologic findings of the three patients were uniform with respect to a prior history of cholecystectomy, multi-lobulated 'coral-like' abscess under CT and epithelioid granulomas in the periphery of the abscess. Achromobacter xylosoxidans is an unrecognized cause of liver abscess in humans.

KLEBSIELLA PNEUMONIAE PRIMARY LIVER ABSCESS IN A NEWLY DIAGNOSED DIABETIC

A 48 year old male presented with cough, fever, and chills for 1 week and right sided pleuritic chest pain of 3 days duration. He had a 20 pack year history of smoking, and abused alcohol. He denied any past medical history including recent travel. He had tachycardia and tachypnea with a fever of 103.5 F. Physical exam was unremarkable. WBC count was 13,100/mm3, with 94% neutrophils. Blood glucose was 181 mg %, Bilirubin 1.9 mg/dL, ALT 140 U/L, AST 175 U/L, alkaline phosphatase 185 U/L and LDH 386 U/L. Chest × ray was suspicious for a right lower lobe infiltrate. The patient was started on Ceftriaxone and Azithromycin for pneumonia. Over the next few days, fever and chills subsided and the pain diminished becoming localized to the right upper quadrant of the abdomen. The liver enzymes improved. Blood cultures sent on admission grew Klebsiellapneumoniae sensitive to all antibiotics except ampicillin. An abdominal CT revealed a 9 × 1 1cm abscess in the right lobe of the liver with multiple small nodules (< 1cm) in the lower lobe of the lungs CT guided catheter drainage of the abscess grew K. pneumoniae with the same antibiotic resistance pattern as in blood. After three weeks of parenteral broad spectrum cephalosporins the patient was discharged on oral antibiotics. Six weeks after admission a repeat abdominal CT revealed a much smaller abscess in the right lobe. The lung nodules resolved. The patient remained asymptomatic and continued to take antibiotics. K. pneumoniae was reported as the most common cause of liver abscess in Taiwan, Singapore and Korea between 1990 and 1999. They still remain a rare cause of liver abscess in North America. Diabetes mellitus is an established risk factor. CT guided drainage and third generation cephalosporins are the suggested treatment. Endopthalmitis, meningitis, septic pulmonary emboli and necrotizing fasciitis are associated complications. With increasing globalization, we may begin to see an increase in K. pneumoniae primary liver abscess outside Asia.