Features Of Liver Abscess Research Articles

A Case Series and Literature Review of Alveolar Echinococcosis in Kashmir, India: An Emerging Endemic Zone for Echinococcus multilocularis.

A prospective study on 110 patients with echinococcosis at Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India, from March 2019 to April 2024 identified 12 cases (4 males, 8 females; mean age of 46.58 ± 11.97 years) of Alveolar echinococcosis (AE). Two patients were detected through ultrasound examinations carried out for unrelated causes; one presented with features of liver abscess, and nine had pain in the right upper quadrant for a mean period of 2.2 ± 1.79 years. All had the liver as the primary organ involved, with 15 tumor masses of a mean maximum diameter of 9.22 ± 3.21 cm and volume of 426 ± 374.61 cm3. Tumors placed centrally had invaded vessels and the biliary tract in eight patients, and those placed peripherally had invaded the liver capsule and adjacent organs in nine patients. Histologic examination of liver biopsies or resected organs revealed necrotic lesions, calcifications, and granulomatous inflammation with slender, thin-walled vesicles of bizarre configuration that stained strongly eosinophilic with periodic acid Schiff. Two patients had segmental liver resections; one was treated with liver aspiration, while the other nine with advanced disease received chemotherapy with albendazole along with praziquantel. Patients showed clinical improvement on a median follow-up of 12 months (range 1 to 60 months); however, MRI T2-weighted images and 18F-FDG-PET-CECT scans in two patients showed active disease on follow-up at one and five years, respectively. A systematic review detected 146 cases of AE in India from 1980 to April 2024. Twenty cases were from foreign countries, mostly from Central Asian republics, and 118 (93.65%) of the remaining 126 Indian patients were permanent residents of Kashmir Valley. The disease affected a population of 79,197 residing in 22 villages from 5 border districts of the valley. These villages were either high in or adjacent to the Himalayan mountain range. Disease prevalence in the affected population was 146.47/105 (males 131.53/105 and females 163.18/105) and the incidence was 12.41/105/year (males 11.16/105/year and females 13.81/105/year). Possible causes of the emergence of AE are discussed, and future directions for research to face this challenge arebeen identified.

An Unusual Case of Liver Abscess Caused by Trematodes

Liver abscess caused by trematodes is considered highly unusual. Here we present a case of an elderly female with no knowncomorbidities, who presented with fever and right upper quadrant pain. Upon evaluation, she was found to have features ofliver abscess on abdominal ultrasound and 640-slice computed tomography (CT) of the abdomen. Ultrasound-guided needlebiopsy of the liver showed features of trematode. Patient was treated with oral nitazoxanide. Patient’s fever and abdominalpain subsided after the treatment.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

BackgroundThere is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes.MethodsWe retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period.ResultsAmongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation.ConclusionsALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

Clinical and computed tomography features of extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae liver abscess

BackgroundKlebsiella pneumoniae (KP) is the primary pathogen associated with pyogenic liver abscesses (PLAs). Moreover, there has been an increase in the proportion of extended-spectrum beta-lactamase (ESBL)-producing KP. However, the clinical and computed tomography (CT) features of liver abscesses caused by ESBL-producing KP have not been separately described. We aimed to compare the clinical and CT features present in patients with ESBL-producing and non-ESBL-producing KP as well as to determine the risk factors for ESBL-producing KP liver abscesses (KPLAs).MethodsWe performed a retrospective analysis of data obtained from the medical records of patients with a first episode of KPLA admitted to Shengjing Hospital of China Medical University between May 2015 and May 2019. We compared the clinical and CT features between patients with ESBL-producing and non-ESBL-producing KPLA.ResultsWe enrolled 100 patients with KPLA (14 and 86 in the ESBL-producing and non-ESBL-producing groups, respectively). There was no significant between-group difference in the proportion of patients with comorbid diabetes (71.43% vs. 66.2%, p = 0.086). The ESBL-producing KPLA group had a greater proportion of patients with a history of biliary disease (78.57% vs. 26.74%, p < 0.001) and gastrointestinal malignancy (50% vs. 6.98%, p < 0.001). Multivariate regression analysis showed that a history of biliary disease was an independent risk factor for ESBL-producing KPLA. Compared with the non-ESBL-producing KPLA group, the ESBL-producing KPLA group had a significantly higher intensive care unit (ICU) admission rate (28.57% vs. 2.33%, p < 0.001). All ESBL-producing KP isolates were susceptible to carbapenems and amikacin. Only the presence of multiloculation on CT was found to be significantly different between the groups (50% vs. 82.56%, p = 0.012).ConclusionsThe presence of biliary disease was an independent risk factor for ESBL-producing KPLA. Patients with ESBL-producing KPLA had a higher ICU admission rate, with only half of patients having evidence of multiloculation on CT.

Characteristics of Liver Abscess in Department of Infectious Diseases at Fann Teaching University Hospital in Dakar, Senegal

Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.

Community-acquired primary liver abscess due to klebsiella pneumoniae in a type 2 diabetic patient

Klebsiella pneumonia (KPLA) liver abscess is a cause of morbidity and mortality in especially diabetic patients. Early case reports have been from the Southeast Asia, also been found in other parts of the world. Diagnosis is usually by culture of hepatic aspirate and/or blood culture and treatment by drainage of abscess and administration of appropriate antibiotics. This is a case of KPLA in a 52-year old man treated and responded to antibiotics. KPLA is an entity that should be sought for especially in poorly controlled diabetic patients when they present with clinical features of liver abscess. Blood culture must always be done especially when aspiration or drainage proves difficult. Use of appropriate antibiotics alone may be successful in treating them if surgical drainage is unsuccessful.

CT Appearance of Pyogenic Liver Abscesses Caused byKlebsiella pneumoniae

To retrospectively compare the computed tomographic (CT) features of liver abscesses caused by Klebsiella pneumoniae with those caused by other bacterial pathogens. This retrospective study was approved by the institutional review board, with waiver of informed consent. Hospital records of all patients with a diagnosis of liver abscess between July 2003 and July 2010 were retrieved from an electronic hospital database. One hundred and thirty-one consecutive patients with confirmed pyogenic liver abscesses were studied. Data on clinical presentation, comorbid conditions, septic hematogenous complications, hospitalization duration, and abscess-related mortality were obtained. CT characteristics of abscesses including number, distribution, unilocular or multilocular appearance, cystic or solid appearance, gas in cavity, pylephlebitis, thrombophlebitis, and pneumobilia were reviewed. Etiology was established by pus and/or blood culture. Patients were placed into a monomicrobial K pneumoniae liver abscess group and a comparison group. A comparison of the CT features and clinical findings between the two groups was performed. The χ(2) analysis or Fisher exact test was used for categorical variables, and Student t and log-rank tests were used for continuous variables. A P value of less than .05 was considered to indicate a significant difference. Monomicrobial K pneumoniae liver abscesses were present in 92 cases (70.2%). On CT images, characteristics more likely to be associated with monomicrobial K pneumoniae liver abscesses than other pyogenic liver abscesses were a single abscess (79.3% vs 56.4%, P = .01), unilobar involvement (82.6% vs 61.5%, P = .01), solid appearance (57.6% vs 35.9%, P = .03), multilocular (94.6% vs 71.8%, P = .01), association with thrombophlebitis (30.4% vs 5.1%, P < .01), and hematogenous complications (28.3% vs 7.7%, P < .01). Thrombophlebitis was associated with higher incidence of hematogenous septic complications (50.0% vs 13.9%, P < .001). Monomicrobial K pneumoniae liver abscesses were associated with significantly shorter duration of antibiotic treatment (P = .018) and hospital stay (P = .005), but there was no significant difference in incidence of septic shock and abscess-related mortality as compared with other pyogenic liver abscesses. Monomicrobial K pneumoniae liver abscesses appear as single, solid, or multiloculated liver abscesses and are associated with thrombophlebitis and septic hematogenous complications.

Liver abscess in children: a 10-year single centre experience.

Background/Aim:Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries.Materials and Methods:The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients’ records retrospectively.Results:There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscesswere immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later ttaken for open drainage, with an overall mortality rate of 5.5%. Conclusion: The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.