Incidence Of Liver Abscess Research Articles

Study of liver abscess in pediatrics patients in tertiary health care institute

liver abscess is mostly occurring due to the infection of bacteria, parasite like amoeba. The incidence of amoebic liver abscess varies all over the world and most of cases found in developing countries remain unreported. study of liver abscess in pediatric patients in tertiary health care institute. This was a prospective study, carried out in 64 at our tertiary care center, J K Lon Hospital, SMS Medical College, Jaipur from May 2022 to April 2023. We collect all data related to patients like demography, clinical features, laboratory finding, and imaging records and recorded on a pre-decided proforma. There were 64 patients (36 male, 56.25% and 28 females, 43.75%), The male to female ratio was 1.25:1. The mean age of presentation was 7.5 years. The common presenting symptom was anorexia in 55 (85.93%) cases. Most common symptom was abdominal pain in 60 (93.75%) cases, fever 58 (90.625%), and vomiting in 40 (62.5%%) cases. Diarrhoea was present in 5 patients. Anemia was most common clinical sign in present in 40 (62.5%) patients, weight loss 38 (59.37%). Respiratory distress was present in 4 (6.25%) due to pleural effusion and peritonitis cases. Jaundice was present in 5 (7.81%) . 5 case [7.81%] of patients had raised bilirubin and 28 patients [43.75%] had raised alkaline phosphatase levels. Raised SGOT and SGPT was 43.75 %. 34 patients of Amoebic liver abscess and 30 of Pyogenic liver abscess. 53.12% (34 cases) patients had amoebic liver abscess in the right lobe. less than 50 cc size of abscess was present in 24 patients (37.5%) cases. Most of the patients have cavity size 50-150cc. more than 200cc cavity found only in 10 cases. Average cavity size is 166cc. peritoneal ruptured liver abscess in 2 cases [3.12%%] had features of peritonitis, pleural effusion in 2 cases with complain of respiratory difficulties. Conservative medical management was done in 2 patients, USG guided needle aspiration 20 patients and 40 patients underwent pigtail catheter insertion. 12 fr pigtail catheter insertion was done in 30 patients and 10 patients underwent double pigtail catheter insertion. Exploration and drainage of liver abscess was done in 2 patients. In present study, mean hospital stay was 10.28 days. Hospital stays ranges from 5 to 17 days. Most of the patients stays 5 to 10 days [56.25%]. all amoebic liver abscesses were sterile. Most commonly found organism on pus culture was Staphylococcus in 25% cases followed by E. coli in 21.87% cases in pyogenic liver abscesses. from this study we found that ultrasonography is the standard modality for diagnostic and therapeutic management as well as for drainage and follow up. We also found that USG guided pigtail catheter drainage is a superior therapeutic approach than needle aspiration for large liver abscess, and abscess cavity resolves better in case of pigtail catheter drainage. We also concluded that ruptured liver abscess can also be managed with two pig tail catheter insertion.

Safety evaluation of combination treatment of drug-eluting bead transarterial chemoembolization and immune checkpoint inhibitors for hepatocellular carcinoma: An increased risk of liver abscess with treatment interval less than one month

PurposeTo analyze the safety of combination treatment comprising drug-eluting bead transarterial chemoembolization (DEB-TACE) and immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC). MethodIn total, 208 HCC patients receiving DEB-TACE were enrolled for this retrospective single-institution study. Among them, 50 patients who received ICIs at an interval less than one month from DEB-TACE were categorized into the DEB-ICI group; the remaining 158 patients were categorized into the DEB group. Albumin-bilirubin (ALBI) score before and at three months after DEB-TACE were recorded to evaluate liver function changes. Adverse events within three months after DEB-TACE were considered TACE-related and were compared between the two groups. ResultsThe DEB-ICI group had significantly higher incidence of liver abscess than the DEB group (14.0 % versus 5.1 %, p-value = 0.0337). No significant difference in the other TACE-related adverse events and change of ALBI score between the groups. Univariate logistic regression confirmed that combination with ICIs was an independent risk factor for liver abscess after DEB-TACE (odds ratio = 3.0523, 95 % confidence interval: 1.0474–8.8947, p-value = 0.0409); other parameters including subjective angiographic chemoembolization endpoint scale and combined targeted therapy were nonsignificant risk factors in this study population. In the DEB-ICI group, patients who received ICIs before DEB-TACE exhibited a trend toward liver abscess formation compared with those who received DEB-TACE before ICIs (23.8 % versus 6.9 %, p-value = 0.0922). ConclusionsCombination treatment involving DEB-TACE and ICIs at an interval less than one month increased the risk of liver abscess after DEB-TACE. Greater caution is therefore warranted for HCC patients who receive ICIs and DEB-TACE with this short interval.

Characteristics and Management of Pyogenic Liver Abscess: A Rural Senegalese Experience

Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context.
 Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal.
 Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%.
 Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.

206. Prevalence of liver abscess in patients with Klebsiella pneumoniae bacteremia during a 5-year experience in a tertiary hospital in Thailand

Abstract Background The incidence of liver abscess in Thailand has increased in number nowadays. K. pneumoniae is the most common cause of pyogenic liver abscess in the recent large series. Liver abscess can be a complication of K. pneumoniae bacteremic patients. We aimed to study the prevalence of liver abscess in patients with K. pneumoniae bacteremia and the comparison in clinical and laboratory characteristics of patients with K. pneumoniae between a group with liver abscess and the other without liver abscess. Methods This is a retrospective study; data were collected in Bhumibol Adulyadej Hospital among patients who were diagnosed with K. pneumoniae bacteremia between January 2014 – December 2019 and compared the difference in clinical and laboratory characteristics of patients between a group with liver abscess and the other without liver abscess. Results Of All 758 patients with K. pneumoniae bacteremia, 335 (44.19%) patients were done abdominal imaging, and 37 (4.9%) patients were found with liver abscess. The mean age was 65 years old, and most were male. Comorbidities were present in almost half of the patients including diabetes (118 patients, 35.22%), previous hepatobiliary surgery (21, 6.26%), and history of cancer (70, 20.90%). The other demographic data are shown in Table 1. Patients with liver abscess had diabetes (54.1% vs 29.3%, p-value = 0.082) and fever (91.89% vs 76.84%, p-value = 0.056) more than patients without abscess, however only 29.7% of patients with liver abscess had abdominal pain. Elevated transaminases above 2 times the upper limit of normal range are more frequent among patients with liver abscess than patients without abscess, for AST; 54.1%vs 35.30% (p-value = 0.026) and ALT; 40.5% vs 25.20% (p-value = 0.048). Clinical and laboratory characteristics are shown in Table 2.Table 1:Demographic data of patients with K. pneumoniae bacteremiaTable 2:Clinical and laboratory characteristics of patients with K. pneumoniae bacteremia Conclusion The prevalence of liver abscess in patients with K. pneumoniae bacteremia is 37 from 758 (4.9%). Liver abscess should be suspected in K. pneumoniae bacteremic patients who have elevated transaminases above 2 times the upper limit of normal range regardless of abdominal pain. Disclosures All Authors: No reported disclosures

Liver abscess after drug-eluting bead transarterial chemoembolization for hepatic malignant tumors: Clinical features, pathogenesis, and management.

The study aimed to investigate the clinical features, incidence, pathogenesis, and management of liver abscess after drug-eluting bead transarterial chemoembolization (DEB-TACE) for primary and metastatic hepatic malignant tumors. From June 2019 to June 2021, patients with liver abscess after DEB-TACE for primary and metastatic hepatic malignant tumors were reviewed and evaluated at our hospital. Demographic and clinical data, radiological findings, management approaches, and prognosis were retrospectively analyzed. In total, 419 DEB-TACE procedures were carried out in 314 patients with primary and metastatic liver tumors at our medical center. Twelve patients were confirmed to have liver abscesses after DEB-TACE through clinical manifestations, laboratory investigations, and imaging. In this study, the incidence of liver abscess was 3.82% per patient and 2.86% per DEB-TACE procedure. After percutaneous drainage and anti-inflammatory treatments, 10 patients recovered, and the remaining 2 patients died due to direct complications of liver abscess, such as sepsis and multiple organ failure. The mortality rate of liver abscesses after DEB-TACE was 16.7% (2/12). The incidence of liver abscess after DEB-TACE is relatively high and can have serious consequences, including death. Potential risk factors could include large tumor size, history of bile duct or tumor resection, history of diabetes, small DEB size (100-300μm). Sensitive antibiotics therapy and percutaneous abscess aspiration/drainage are effective treatments for liver abscess after DEB-TACE.

Profile of Amoebic vs Pyogenic Liver Abscess and Comparison of Demographical, Clinical, and Laboratory Profiles of these Patients From a Tertiary Care Center in Northern India

Amoebic liver abscess (ALA) and pyogenic liver abscesses (PLA) are the most common causes of liver abscess in developing and developed countries, respectively. Although incidence of liver abscess is low, but mortality is high amongst the patients due to delayed diagnosis. The study was done to find out the prevalence of amoebic and PLA among patients of liver abscess. The clinical, personal, and demographical details were also evaluated to find out the risk factor(s) associated with ALA and PLA, respectively. A retrospective study was conducted to find the prevalence of amoebic and PLA. Clinical, demographic, personal details were evaluated from hospital records. Laboratory parameters such as total leucocyte count, platelets, bilirubin, ESR (Erythrocyte Sedimentation Rate), hemoglobin, glycosylated hemoglobin (HbA1c), alkaline phosphate (ALP), Aspartate aminotransferase (SGOT/AST), Alanine aminotransferase (SGPT/ALT), serum albumin, bilirubin levels, and procalcitonin were recorded. The Ultrasonography (USG) findings regarding the size, location, volume, and number of abscesses were also analyzed. Total of 107 patients of liver abscess were evaluated, and 61.6% of patients were of amoebic etiology, and 25.3% were of pyogenic etiology. Males of 20-60 years of age were predominantly affected with right upper quadrant pain and fever as the most common presentations. ALA patients were found to have solitary abscess in the right lobe involving 6th and 7th segments, with decreased hemoglobin, hyperbilirubinemia, elevated ALP and SGOT, with normal SGPT, and addiction to alcohol. PLA patients had increased HbA1c, increased PCT values, low serum albumin levels, and low platelet-to-white blood cellvalues. The most common bacteria causing PLA was Escherichia coli (n= 8) followed by Enterobacter cloacae (n= 5). Mortality was seen in 6 patients. Liver abscess is found to have relatively high mortality and morbidity. Therefore, early diagnosis is the only method to prevent mortality and morbidity in these patients. Since the presentation is very nonspecific, evaluation of certain risk factors and laboratory parameters can aid in the diagnosis.

Clinical manifestations, diagnosis, treatment, and outcome of pyogenic liver abscess: a retrospective study.

The incidence of pyogenic liver abscess (PLA) continues to rise, yet atypical clinical symptoms result in considerable incidence of misdiagnosis. This study was conducted to identify potential warning indicators and summarize efficacious diagnostic and therapeutic approaches for potential clinical guidelines. Hospitalized patients aged ≥18 years and diagnosed with PLA were included in this retrospective study. Data were collected from participant's clinical records. Patients were grouped according to type 2 diabetes mellitus status and ultrasound-guided percutaneous drainage (USPD). Between-group differences were analysed with Student's t-test. A total of 104 hospitalized patients were included, 33 of whom (31.73%) had type 2 diabetes. Procalcitonin levels were raised in all patients, suggesting potential effectiveness and sensitivity as a warning marker for PLA. Contrast-enhanced computed tomography was the most frequently used method (63.46% of cases) for diagnosing PLA. Klebsiella pneumoniae was the main pathogen found in patients with PLA in southeast China (isolated in 92.86% [26/28] of positive blood cultures and 90.70% [39/43] of positive abscess fluid cultures). Duration of hospital stay was shorter in patients who received USPD versus those who did not (17.91 ± 6.84 days versus 21.47 ± 9.82 days). Types of PLA-susceptible patients, infection markers, highly sensitive imaging techniques and clinical treatment options were identified. These results may help with early accurate diagnosis of patients with PLA, avoiding treatment delay.

Diabetes and obesity and risk of pyogenic liver abscess

Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22–3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37–4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose–response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05–1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09–2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.

Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020

Background Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden. Methods This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision). Results A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3–97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8–5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes. Conclusion The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial.

“A COMPARATIVE STUDY OF USG GUIDED PERCUTANEOUS CATHETER DRAINAGE VERSUS USG GUIDED PERCUTANEOUS NEEDLE ASPIRATION IN THE MANAGEMENT OF LIVER ABSCESS”

Background: The incidence of liver abscess both pyogenic and amoebic is steadily increasing. Liver abscess is a potentially curable condition and without treatment the mortality is very high. The aim and objective of the study is to compare and correlate the therapeutic effectiveness of percutaneous needle aspiration and percutaneous catheter drainage in the management of liver abscess and to indicate the various determinants that affect the success of both the procedures. To identify and compare the morbidity and side effects associated with percutaneous catheter drainage and percutaneous needle aspiration. To compare the cost effectiveness of both the treatment options.

Increased Incidence of Pyogenic Liver Abscess in a Midwest System With Emphasis on Rural Impact.

Objective: To assess if hepatic abscess incidence in a Midwest cohort was higher in rural areas compared to metropolitan areas in relation to water infrastructure.Materials and methods: All cases of hepatic abscesses from Jan 1, 2016 through Dec 31, 2019 at Avera McKennan Hospital in Sioux Falls, South Dakota (SD), were retrospectively collected. Chart review was completed for each case for risk factor analysis. Microbiology cultures and patient demographic data were collected including age, gender, hometown, and ethnicity. Risk factors assessed included a history of abdominal surgery, gallbladder disease, sepsis, diverticulitis, cancer, and diabetes. The incidence of hepatic abscesses was calculated using the Poisson rate test and confidence interval equation. Averages of each risk factor were calculated. Finally, hometown was utilized to create a heatmap of disease burden and compared to the density of private wells.Results: Our data yielded 116 confirmed adult hepatic abscesses between 2016 and 2019. The corrected incidence per 100,000 hospitalized patients per year is 95.66. The Poisson exact probability P-value was <0.01. Rural areas had a higher per capita incidence of abscesses and higher density of private wells.Conclusions: The incidence of hepatic abscesses is higher than national averages in this single-center study of Avera McKennan Hospital. Demographics, especially geographic location, play an important role in abscess rates. Rural location may be affecting the incidence of hepatic abscesses, explaining the much higher than expected incidence in this study. Infrastructure could be a contributing factor as much of the rural area is reliant on untreated groundwater.

CLINICAL, BIOCHEMICAL, AND IMAGE CHARACTERISTICS IN PATIENTS WITH A DIAGNOSIS OF AMEBIC AND BACTERIAL LIVER ABSCESS.

A hepatic abscess (HA) accumulates purulent material in the liver parenchyma and can be of bacterial, parasitic, fungal, or mixed origin. The incidence ranges from 2.3 to 22 per 100,000 people. In Mexico, the annual incidence of amoebic liver abscess is 6.7 per 100,000 population. To determine the clinical, biochemical, and imaging characteristics in patients diagnosed with amoebic and bacterial liver abscess. Research design: Descriptive, cross-sectional/prevalence. We analyzed medical records of patients admitted during 2019 with a diagnosis of liver abscess and who had an amoeba PCR test. The qualitative variables were expressed in frequencies and percentages; the numerical variables were mean and standard deviation. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of a total of 32 patients admitted with a liver abscess in Gastroenterology during 2019, 20 patients treated with drainage and PCR test for amoeba of the abscess fluid were included. Of these, 85%(17) were men with a mean age of 45.35±10.93 years, and 55%(11) were of bacterial etiology. Regarding the characteristics due to their etiology (amoebic vs. bacterial): 30%(6) were presented in segments VII and VIII; [33.3%(2/6) amoebic vs. 66.7%(4/6) bacterial]. According to the number, they were multiple; 28.6%(2/7) amoebic vs 71.4%(5/7) bacterial, unique; 53.8%(7/13) amoebic vs 46.2%(6/13) bacterial, without significant difference (p = 0.37). 60%(12) presented with pleural effusion, and of these, 58.3%(7) were amoebic. 100% were drained, of which 50% were by catheter with a diameter of 14Fr. Regarding the laboratory studies: 80%(16) of those with amoebic etiology had cultures of the abscess fluid without development, the leukocytes were 18.65 ± 6.55mm3 with a range of 16.5 in the amoebians vs. 14.58±6.51mm3 with a range of 17.6 in bacteria, Hb of 12.10±1.93 gr/dl in amoebians vs. 12.18 ± 1.72 gr/dl in bacteria and with procalcitonin of 18.06±12.77 gr/dl in amoebic vs. 19.98±59.76 gr/dl in bacterial. According to the imaging studies: the USG diameter was 10.67±2.78cm in amoebians vs. 10.53±4.91cm in bacteria and with a volume of 375.08±263.95 with a range of 782.0cm3 in amebic vs. 441.80±393.90 with a range of 1362.1cm3 in bacterial. Common etiologic agents for HA are E. histolytica (amoebic), bacterial (pyogenic), Mycobacterium tuberculosis, and various fungi. They tend to affect the younger population, especially men with immunosuppression, diabetes, and alcohol consumption. In developing countries, two-thirds are of amoebic origin and in need of puncture drainage. Our study observed that half had amoebic etiology corroborated by amoeba PCR, the majority unique, and almost all required drainage with diameters greater than 5cm by USG. In the present work, we can show that half of the patients diagnosed with a liver abscess in the Gastroenterology Service are of amoebic origin and have similar characteristics to those described in the international bibliography. The authors declare that there is no conflict of interest.

English

BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood &amp; Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children

English

BACKGROUND Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. Diagnosis of liver abscess can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Children have unique set of predisposing causes for liver abscesses. The purpose of this study was to assess the clinical, demographic, and etiological profile of liver abscess in children between 1 month to 12 years of age. METHODS This is a prospective observational study conducted in the Department of Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt. of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi), Delhi from July 2016 to August 2017. All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children aged less than 7 years. Informed assent was taken from children aged more than 7 years, along with written and informed consent from their parents/guardians. Their clinical characteristics, radiological features and laboratory data were analysed. RESULTS Most common age group suffering from liver abscess was 5 - 10 years with male preponderance. Majority of the children belonged to lower socio-economic class and half of them were suffering from malnutrition. Most common clinical presentation of children suffering from liver abscess was fever with pain abdomen and tender hepatomegaly. Majority of the children had leucocytosis, high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Deranged liver function test with coagulopathy was noted in more than half of the children suffering from liver abscess. Commonest bacterial pathogen was methicillin resistant Staphylococcus aureus followed by Salmonella typhi, Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent causing liver abscess in children. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Most cases involve a single lesion on right lobe of the liver. Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the two most common pathogens. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children

S3648 Pyogenic Liver Abscess: Where Did It Come From, How Did It Grow?

Introduction: Liver abscesses are suppurative space occupying lesions resulting from the invasion of the liver tissue by insult/injury, intraabdominal infection disseminated from the portal venous circulation, or originate in the biliary system. Three different etiologies consist of pyogenic, amebic and fungal abscesses. The common cause of liver abscess in the United States is bacterial intraabdominal source. Additionally, the right lobe of liver is mostly an affected region as it’s predominately supplied by superior mesenteric vein. We describe an unusual case of right hepatic lobe abscess with unidentifiable source. Case Description/Methods: We present a 79-year-old woman with a medical history of diabetes and hypertension who presented with complaint of fatigue. She otherwise denied recent illness, travel, hospitalizations or intestinal infections. On presentation, she was hypotensive and admission labs significant for neutrophil predominant leukocytosis. The patient exhibited right upper quadrant tenderness. Blood cultures were obtained. Broad spectrum antibiotics were started. Pertinent imaging revealed a hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver. Interventional radiology performed a biopsy and aspiration of 60 mL purulent fluid. Blood cultures grew Bacteriodes fragilis. Surgical liver pathology was predominately fragments of necrotic hepatic tissue with acute inflammation. Liver abscess cultures speciated Escherichia coli, Klebsiella pneumonia, and Streptococcus intermedius. Antibiotics were tailored accordingly. This prompted an echocardiogram which was negative for valvular vegetations. The patient opted for outpatient colonoscopy for further evaluation. Repeat liver imaging showed enlarging abscess, therefore drain was placed. Patient was sent home on 6 week course of antibiotics. Discussion: While the incidence of liver abscess is low, it is essential to have a complete understanding of the disease activity and harm potential because the severity of these abscesses have a high mortality if left untreated. The physiology of disease is so delicate in these patients that an abscess located in the liver parenchyma close to the diaphragm can cause referred pain to the right shoulder or potentially a cough caused by diaphragmatic irritation. Although imaging was negative for etiology of the abscess, the workup is still in progress. This case highlights the importance of antibiotic therapy with drain placement to achieve source control and clinical and bacteriologic cure.Figure 1.: CT imaging demonstrating hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver.

Influences of timing of liver abscess control and early metabolizable amino acid supplementation on feedlot growth-performance and digestive function of calf-fed Holstein steers

Our objective was to examine the influence of timing of liver abscess control and early rumen-protected AA supplementation on cattle growth performance (Exp. 1) and digestive function (Exp. 2), and related responses on liver abscess incidence and AA supply to the small intestine of feedlot steers. In Exp. 1, a total of 200 calves were used in a 321-d experiment. Four strategies for liver abscess control using virginiamycin (VM; 16 mg of VM/kg of diet DM, Phibro Animal Health) were used: (1) 0% VM; (2) VM supplementation during the initial 168 d; (3) VM supplementation during the final 153 d; and (4) VM supplemented continuously for 321 d. During the initial 168-d feeding period, 2 levels of rumen-protected Met and Lys (Smartamine ML: SML; 0 vs. 0.6% DM basis, Adisseo) were supplemented across VM treatments in a 2 × 4 factorial arrangement. In Exp. 2, 4 Holstein steers (382 ± 23 kg) with cannulas in the rumen and proximal duodenum were used in a 4 × 4 Latin square design to evaluate treatment effects on digestion. Cattle growth performance was not affected ( P ≥ 0.18) by VM supplementation strategy. Moreover, VM supplementation did not affect ( P ≥ 0.10) carcass characteristics. Liver abscess incidence was low (4%) and not affected ( P ≥ 0.62) by supplementation strategy. Supplemental VM did not affect characteristics of ruminal and total-tract digestion ( P ≥ 0.27). Supplementation of SML during the first 168 d decreased ( P = 0.02) DMI during the last 153 d of the experiment, and tended to decrease ( P = 0.07) overall (321-d) DMI. Smartamine ML supplementation did not affect ( P ≥ 0.11) ADG, G:F, carcass characteristics, percentage of abscessed liver, or characteristics of ruminal and total-tract digestion. Timing of VM supplementation did not influence cattle growth performance or incidence of liver abscess, which was low (4%) regardless of VM treatment. Protected Met and Lys supplementation increased Met or Lys supply to the small intestine. However, MP and AA supplies of the basal diet, alone, were apparently adequate to achieve expected growth performance.

A rare case of caudate lobe liver abscess

Indian subcontinent has high incidence of both amoebic and pyogenic liver abscess. Currently most of the liver abscesses are managed with interventional radiology based percutaneous drainage (either ultrasound or CT guided). Caudate lobe liver abscess is both a rare and at a peculiar location for such intervention as well as carries a high risk of rupture posing a great challenge for the surgeon in planning the appropriate management. In view of viscinity to vascular structures and viscera near liver hilum and difficult approach by laparoscopic technique, open surgical drainage seems to be a feasible option.

PSVII-20 Supplementing pHix-Up® to feedlot cattle consuming a corn-based finishing diet

Abstract This experiment evaluated the inclusion of a rumen-buffering agent on performance and carcass traits of feedlot cattle. Angus-influenced steers and heifers (n = 64 animals/sex) were ranked by sex and body weight (BW) into 1 or 16 drylot pens. Pens were randomly assigned to receive a corn-based diet without (CON = 8 pens) or with the inclusion (SUPP = 8 pens) of pHix-Up® (magnesium-based product; Timab, Dinard, France) at 0.50% of diet dry matter. Both dietary treatments contained monensin Na (360 mg animal/daily) but did not contain tylosin. Two animals per pen were equipped with an intraruminal bolus (smaXtec Premium Bolus, smaXtec Animal Care GmbH, Graz, Austria) that recorded pH every 15 min. Cattle received treatments for 128 d until slaughter. No differences (P ≥ 0.22) between SUPP and CON cattle were noted for BW gain (0.93 vs. 0.97 kg/d, respectively), feed intake (7.51 vs. 7.78 kg/animal daily, respectively), or feed efficiency (0.121 vs. 0.125 kg/kg, respectively). Rumen pH was greater in SUPP vs. CON cattle during 33% of the time (e.g. 6 h of the day; mean pH of 5.87 vs. 5.80, respectively). No treatment differences were noted (P ≥ 0.12) for carcass merit. Incidence of cattle with liver abscess upon slaughter was greater in CON vs. SUPP (16.4 vs. 4.7%, respectively), including incidence of severe liver abscess (A+; 8.2 vs. 0.0%, respectively). These results indicate that pHix-Up® inclusion into a corn-based finishing diet improved rumen pH without benefiting cattle productive responses. It should be noted that average temperature-humidity index during this experiment was 78, which hindered feed intake and potential benefits of pHix-Up® to rumen pH and cattle performance. Nonetheless, pHix-Up® inclusion substantially reduced the incidence of liver abscess, resulting no severe diagnoses. Hence, additional research is warranted to further explore the benefits of pHix-Up® to feedlot cattle.

Current Status of Amebic Liver Abscess in Korea Comparing with Pyogenic Liver Abscess.

With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess. Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period. Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.

Management Strategies and Clinicopathological Evaluation of Liver Abscess in the Tribal Area: A Cross Sectional Study

Background: Liver abscess continues to be disease with considerable mortality in our country especially in Tribal Area. Locally made alcoholic drinks like neera, arrack may be the routes of faeco-oral transmission of amoebic cysts. Hence the aim of the study was to study the influence of alcohol, diabetics &amp; immunocompromised diseases leading to increased incidence of Liver abscess and to evaluate efficacy associated with most effective treatment. Subjects and Methods: The present study included 50 patients diagnosed with liver abscess. All the patients were under the treatment for the period of years. All cases of liver abscess diagnosed clinically and/or ultrasonographically, all cases of bacterial and parasitic liver abscess and the cases in evolving, liquefied &amp; ruptured stage with or without peritonitis were included in the study. Results: When the management part of the liver abscess was analysed 14 patients had abscess that was less than 200 cc or had multiple small abscess involving both lobes that were managed conservatively. Total of 36 patients who had abscess &gt; 200 cc or left lobe abscess were subjected to intervention, of which 24 patients were treated with percutaneous aspiration with antibiotic coverage, 6 patients were treated with laparotomy procedure and 4 patients treated with drainage with laparoscope and 2 patients underwent ICD insertion. Conclusion: Liver abscess is a common condition in tribal area of India. It is still, a disease associated with considerable morbidity. Intraperitoneal rupture, pleural rupture, septicemia are the conditions that can occur. Multiple small liver abscess and solitary liver abscess &lt; 200 cc or size &lt; 5cms can be successfully managed with conservative line of management with antimicrobials / antiamoebic drugs, but recurrences were noted. Percutaneous needle aspiration as well as Pigtail Catheter insertion is safe and highly effective method of managing liver abscess cases. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.