Liver Abscess Research Articles

Development of a nomogram to assess thromboembolic risk in patients with liver abscesses

Thromboembolism, a serious complication in patients with liver abscesses, can lead to organ deterioration if left untreated. However, factors associated with thromboembolism in these patients remain poorly understood. We aimed to identify the factors associated with liver abscess complications, with a focus on thromboembolism and metastatic infection. Data from 325 patients diagnosed with liver abscesses between March 2019 and June 2023 were retrospectively collected. Baseline clinical and laboratory variables associated with thromboembolic events and metastatic infections were analyzed using logistic regression. A nomogram for predicting thromboembolism was constructed using significant predictors. Among the 325 patients, the median age was 68.0 years, and included 129 women. Fifty patients experienced thromboembolic events and 44 had metastatic infections. Significant predictors for thromboembolic events included white blood cell (WBC) ≥ 20,000/µL (odds ratio [OR] 3.401, p = 0.002), platelet count < 100,000/µL (OR 3.291, p = 0.004), and abscess septation (OR 2.704, p = 0.007). Age ≥ 65 years (OR 0.457, p = 0.040), WBC ≥ 20,000/µL (OR 3.340, p = 0.005), and abscess septation (OR 2.909, p = 0.008) were identified as factors associated with metastatic infections. A nomogram was constructed to predict thromboembolism using the following four variables: WBC ≥ 20,000/µL platelet count < 100,000/µL, albumin < 2.8 g/dL, and abscess septation, and demonstrated an AUROC of 0.755. Our study is the first to develop a reliable nomogram for thromboembolism prediction, utilizing easily accessible clinical parameters. This innovative model enables clinicians to efficiently identify high-risk patients, facilitating the implementation of additional studies to mitigate the risk of overlooked thromboembolic events in these at-risk individuals.

Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: A WTA multicenter study.

Prior studies evaluating observation versus angioembolization (AE) for blunt liver injuries (BLT) with contrast extravasation (CE) on computed tomography imaging have yielded inconsistent conclusions, primarily due to limitations in single-center and/or retrospective study design. Therefore, this multicenter study aims to compare an observation versus AE-first approach for BLT, hypothesizing decreased liver-related complications (LRCs) with observation. We conducted a post hoc analysis of a multicenter, prospective observational study (2019-2021) across 23 centers. Adult patients with BLT + CE undergoing observation or AE within 8 hours of arrival were included. The primary outcome was LRCs, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. A multivariable logistic regression analysis was used to evaluate risk factors associated with LRCs. From 128 patients presenting with BLT + CE on imaging, 71 (55.5%) underwent observation-first and 57 (45.5%) AE-first management. Both groups were comparable in age, vitals, mechanism of injury, and shock index (all p > 0.05), however the AE group had increased frequency of American Association for the Surgery of Trauma Grade IV injuries (51.0% vs. 22.0%, p = 0.002). The AE cohort demonstrated increased rates of in-hospital LRCs (36.8% vs. 12.7%, p = 0.038), emergency department representation (25.0% vs. 10.0%, p = 0.025), and hospital readmission for LRCs (12.3% vs. 1.4%, p = 0.012). However, the two cohorts had similar mortality rates (5.7% vs. 5.3%, p = 0.912). After adjusting for age, ISS, and grade of liver injury, an AE-first approach had a similar associated risk of LRCs compared with observation-first management (odds ratio, 1.949; 95% confidence interval, 0.673-5.643; p = 0.219). Patients with blunt liver injury and CE undergoing an observation-first approach were associated with a similar adjusted risk of LRCs and rate of mortality compared with AE-first approach. Overall, this calls for reevaluation of the role of routine AE in blunt liver trauma patients with CE. Future prospective randomized trials are needed to confirm these findings. Therapeutic/Care Management, Level IV.

Asymptomatic presentation of giant liver abscess: simultaneous Klebsiella pneumoniae and amoebic infection in an immunocompetent comorbid patient

Liver abscess is a rare clinical entity, giant abscess is also rare and asymptomatic presentation in immune competency is even rare. Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients, just few articles. Our case, a 69-year-old man was discovered to have hypoechoic liver mass during a scan of the abdomen for evaluation of dysuria. He was hospitalized through ER for advanced assessment. Systemic inquiries of the patient revealed generalized fatigue, constipation, but no fever, chills, abdominal pain or hypotension. Physical examination revealed normal liver span and no right upper quadrant tenderness. Tumor markers were not strikingly high and an enhanced abdominal computed tomography showed a large area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 220 ml of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 3 weeks on treatment with meropenem and metronidazole, along with sustained drainage of the abscess cavity. No parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. Giant size, possible coexistence of amoebae and bacteria in a liver abscess and asymptomatic presentation should not be discounted.

Surgical treatment of extraintestinal amoebiasis with development of right lobe liver abscess: case study

The treatment of extraintestinal amoebiasis is a major surgical concern given the low prevalence in the Republic of Belarus and consequently difficult diagnosis. In this article, we present our own experience with the surgical treatment of a patient with an amoebic liver abscess. The patient underwent laparoscopy guided drainage of the abscess of the right lobe of the liver according to the technique developed in the clinic. A puncture-drainage system consisting of a Foley catheter and a guide stylet was used. The patient was discharged in satisfactory condition for outpatient treatment and observation by a surgeon, a general practitioner, and an infectious disease specialist. There were no repeated visits or admissions. The presented case emphasizes the importance of combined treatment of amoebic liver abscesses using percutaneous drainage and conservative therapy with amoebicidal drugs such as metronidazole.

A novel murine wire injury based infectious endocarditis model aggravates aortic valve stenosis

Abstract Background With mortality rates up to 40% under optimal medical treatment, infectious endocarditis (IE) remains one of the deadliest infectious diseases worldwide. In the early stages of IE, diagnosis and treatment initiation are often difficult and research is limited due to unreliable models. Most murine IE models rely on permanent prosthetic wire placement and i.v. bacterial injection, thus making it inadequate to study IE pathophysiology with the aim to reflect the course of disease in humans. Purpose To develop a reproducible murine IE model, based on aortic valve injury preceding intravenous S. aureus bacterial challenge. Methods Using a wire-injury model we induced endothelial lesions. 72h after wire injury (WI), we performed intravenous bacterial challenge using S. aureus. Echocardiography was performed to confirm bacterial vegetations and assess valvular function. Cross sections of valvular leaflets were prepared for scanning electron microscopy (SEM). Macrophage, neutrophil and S. aureus-specific immunofluorescence staining was performed and visualized by immunofluorescence microscopy. Bacterial cultivation was performed from peripheral blood and valve tissue. Systemic immune response was analyzed using flow cytometry. Results WI induced endothelial damage in all mice verified using scanning electron microscopy imaging. The combination of wire injury and injection of 10^5 and 10^6 colonies-forming-units (CFU) S. aureus reliably caused IE validated via in vivo echocardiography as well as S.aureus immunofluorescence staining and SEM imaging. Mice undergoing bacterial challenge responded with significant neutrophilia in the blood. Using 10^6 CFU S. aureus was associated with an increased mortality, liver and kidney abscess formation due to systemic bacterial spreading compared to 10^5 CFU. Peak velocity across the aortic valve and aortic valve leaflet thickness as markers for aortic valve stenosis were increased in IE compared to WI only mice. Aortic regurgitation was more prevalent after bacterial challenge mediating increased left ventricular volumes, meanwhile ejection fraction was not altered. Immunofluorescence staining revealed a pro-inflammatory milieu including increased macrophage and neutrophil infiltration in IE compared to WI only mice. Conclusion In vivo echocardiography and ex vivo histological staining revealed reliable IE induction using our new model with S. aureus concentrations of 10^5 CFU. The additional bacterial challenge causes a more severe aortic valve stenosis compared to WI only mice, potentially due to an observed increase in valvular inflammation.Fig 1 Scanning electron microscopy after

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.

Leukopenia-a rare complication secondary to invasive liver abscess syndrome in a patient with diabetes mellitus: A case report

Leukopenia-a rare complication secondary to invasive liver abscess syndrome in a patient with diabetes mellitus: A case report

Pyogenic Liver Abscess and the Important Role of Point-of-Care Ultrasound (POCUS) in Daily Practice: A Report of Two Cases

Pyogenic Liver Abscess and the Important Role of Point-of-Care Ultrasound (POCUS) in Daily Practice: A Report of Two Cases

Multiple Liver and Jejunal Abscesses Due to Fasciola Flat Worm: An Uncommon Case Report from Iran.

Fascioliasis is a zoonotic condition precipitated by the trematode known as Fasciola spp. This parasite affected almost 2.4 to 17million individuals in the world. The occurrence of liver abscesses is an infrequent phenomenon, potentially arising as a secondary outcome of cholangitis or hepatic inflammation. In this study, we have reported a case of a hepatic abscess induced by Fasciola spp. A 29-year-old male presented with generalized abdominal discomfort, primarily concentrated in the right upper quadrant, which had progressively worsened over the past seven months. The patient did mention a weight loss of approximately 10kg during the course of their illness, along with increasing fatigue. Eosinophilia was seen too (35%). The stool exam test was negative. An enteroscopy was conducted, revealing no pathological abnormalities. Following this, the surgeon prescribed a surgical biopsy of the mass, which yielded a diagnosis of multiple eosinophilic granulomatous abscesses within the jejunal wall and mesentery. The Fasciola IgG test returned a positive result. After of follow-up, the patient fully recovered. Fascioliasis should be considered in the differential diagnoses of liver abscesses. Because of earlier diagnosis, can be avoided of invasive diagnostic tests and therapeutic interventions can be started earlier.

A unique case of hypervirulent Klebsiella pneumoniae invasive syndrome with endogenous endophthalmitis and left renal vein thrombosis without liver abscess

Introduction: This case report presents a rare instance of hypervirulent Klebsiella pneumoniae invasive syndrome (KPIS) without hepatic involvement. It highlights an atypical presentation as this syndrome is characterized by liver abscesses. Case Presentation: A 54-year-old female of South Asian descent presented to the emergency department with abdominal pain, fever, chills, nausea, and vomiting. Lab investigations showed hyperglycaemia, leukocytosis, and elevated procalcitonin. Imaging revealed bilateral acute pyelonephritis with early abscess formation in the left kidney, bilateral pleural effusions, diffuse multi-lobar consolidations, minimal ascites, and left renal vein thrombosis. The patient was treated as a case of septic shock secondary to hypervirulent K. pneumoniae with complications evolving into acute pyelonephritis and endogenous endophthalmitis. K. pneumoniae, known for its polysaccharide capsule, can lead to severe complications in immunocompromised patients, such as endogenous endophthalmitis, liver abscess, and pyelonephritis. Endophthalmitis, a critical ocular emergency, can result in permanent vision loss. The patient’s ocular outcomes remain uncertain due to a lack of follow-up, but prompt interdisciplinary intervention led to the resolution of other comorbidities. Conclusion: This case highlights the importance of considering hypervirulent K. pneumoniae as a cause of severe infection without liver abscess. It also underscores the importance of immediate multidisciplinary management to address the systemic complications associated with this infection and the importance of connecting different symptoms to one aetiology.

Rapid Detection of Amoebic Liver Abscess Using Recombinase Polymerase Amplification Assay in Resource-Limited Settings.

Amoebic liver abscess (ALA) is a significant public health concern in tropical countries. Traditional diagnostic methods, such as microscopy, have low sensitivity, and nested polymerase chain reaction (nPCR) has lengthy turnaround times. In this study, we aimed to evaluate the effectiveness of the recombinase polymerase amplification (RPA) assay for detecting Entamoeba histolytica in amoebic liver pus samples. The assay was tested on 150 clinical pus samples collected from suspected ALA patients in the emergency department of a tertiary care center located in Chandigarh, northern India. For comparison with RPA, nPCR was also performed on these samples. Of 150 samples, 79 (53%) tested positive for E. histolytica using the RPA assay, and similar (79; 53%) number of samples tested positive with nested PCR. In addition, sequences obtained through Sanger sequencing showed high similarity with other sequences in the National Center for Biotechnology Information database and were submitted to the database. Our findings highlight the potential of RPA as a valuable tool for the accurate diagnosis of ALA.

Predictive Value of Red Blood Cell Distribution Width-to-Platelet Ratio for Severity in Pyogenic Liver Abscess: A Retrospective Observational Study.

Background: The ratio of red blood cell distribution width (RDW) to platelet ratio (RPR) may have prognostic value in several inflammation-related diseases. However, few studies have been conducted on the value of RPR for predicting the severity of pyogenic liver abscess (PLA). Methods: Patients receiving the diagnosis of PLA from February 2013 to December 2022 were enrolled in this retrospective study. We collected data related to baseline characteristics and laboratory results within the first 24 hours the of admission. The receiver operating characteristic curve and the area under the curve (AUC) were used to evaluate the predictive ability of different indicators for severity in PLA. Results: A total of 278 patients were enrolled. For the prediction of sepsis in PLA, RPR had the highest AUC (0.83; 95% confidence interval [CI], 0.78-0.89) with a sensitivity of 0.78 and specificity of 0.82. For the prediction of septic shock, RPR also had the highest AUC (0.74; 95% CI, 0.60-0.88) with a sensitivity of 0.67 and specificity of 0.79. The best cutoff value for RPR to predict sepsis was 0.08 and to predict septic shock was 0.11. Conclusions: An increase in RPR level serves as a useful indicator with a predictive capacity for severity in PLA.

Synergy of bacteriophage depolymerase with host immunity rescues sepsis mice infected with hypervirulent Klebsiella pneumoniae of capsule type K2.

The hypervirulent Klebsiella pneumoniae (hvKp) with K1 and K2 capsular types causes liver abscess, pneumonia, sepsis, and invasive infections with high lethality. The presence of capsular polysaccharide (CPS) resists phagocytic engulfment and contributes to excessive inflammatory responses. Bacteriophage depolymerases can specifically target bacterial CPS, neutralizing its defense. Based on our previous research, we expressed and purified a bacteriophage depolymerase (Dep1979) targeting hvKp with capsule type K2. Interestingly, although Dep1979 lacked direct bactericidal activity in vitro, it exhibited potent antibacterial activity in vivo. Low-dose Dep1979 (0.1 mg/kg) improved the 7-day survival of immunocompetent mice to 100%. Even at 0.01 mg/kg, mice achieved 100% survival at 5 days, although efficacy sharply declined at doses as low as 0.001 mg/kg. Following Dep1979 treatment, reduced expression of inflammatory factors and no apparent tissue damage were observed. However, therapeutic efficacy significantly diminished in immunosuppressed mice. These findings underscore the critical role of Dep1979 in disarming CPS, which synergizes with host immunity to enhance antibacterial activity against hvKp.

Development and validation of a clinical-radiomics nomogram for the early prediction of Klebsiella pneumoniae liver abscess

Background and aim Pyogenic liver abscess (PLA) is a devastating and potentially life-threatening disease globally, with Klebsiella pneumoniae liver abscess (KPLA) being the most prevalent in Asia. This study aims to develop an effective and comprehensive nomogram combining clinical and radiomics features for early prediction of KPLA. Methods 255 patients with PLA from 2013 to 2023 were enrolled and randomly divided into the training and validation cohorts at a 7:3 ratio. The differences between the two cohorts of patients were assessed via univariate analysis. The radiomics features were extracted from imaging data from enhanced CT of liver abscesses. The optimal radiomics features were filtered using the independent sample t-test and least absolute shrinkage and selection operator, and a radiomics score (Rad-score) was calculated by weighting their respective coefficients. Clinically independent predictors were identified from the clinical data and combined with the Rad-score to develop a nomogram by multivariate logistic regression. The predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and clinical decision curve. Results The nomogram incorporated four clinical features of diabetes mellitus, cryptogenic liver abscess, C-reactive protein level, and splenomegaly, and the Rad-score that was constructed based on seven optimal radiomics features. It had an AUC of 0.929 (95% CI, 0.894-0.964) and 0.923 (95% CI, 0.864-0.981) in the training and validation cohorts, respectively. The calibration and decision curves showed that the nomogram had good agreement and clinical applicability. Conclusions The clinical-radiomics nomogram performed well in predicting KPLA, hopefully serving as a reference for early diagnosis of KPLA.

Droplet Transmission of Streptococcus sanguinis Causing Pyogenic Liver Abscess in a Male Patient With a Transplanted Liver

Droplet Transmission of Streptococcus sanguinis Causing Pyogenic Liver Abscess in a Male Patient With a Transplanted Liver

MRI radiomics model differentiates small hepatic metastases and abscesses in periampullary cancer patients

This multi-center, retrospective study focused on periampullary cancer patients undergoing MRI for hepatic metastasis and abscess differentiation. T1-weighted, T2-weighted, and arterial phase images were utilized to create radiomics models. In the training-set, 112 lesions in 54 patients (median age [IQR, interquartile range], 73 [63–80]; 38 men) were analyzed, and 123 lesions in 55 patients (72 [66–78]; 34 men) comprised the validation set. The T1-weighted + T2-weighted radiomics model showed the highest AUC (0.82, 95% CI 0.75–0.89) in the validation set. Notably, < 30% T1-T2 size discrepancy in MRI findings predicted metastasis (Ps ≤ 0.037), albeit with AUCs of 0.64–0.68 for hepatic metastasis. The radiomics model enhanced radiologists’ performance (AUCs, 0.85–0.87 vs. 0.80–0.84) and significantly increased diagnostic confidence (P < 0.001). Although the performance increase lacked statistical significance (P = 0.104–0.281), the radiomics model proved valuable in differentiating small hepatic lesions and enhancing diagnostic confidence. This study highlights the potential of MRI-based radiomics in improving accuracy and confidence in the diagnosis of periampullary cancer-related hepatic lesions.

A novel K57-specific Klebsiella pneumoniae phage disinfects milk and inhibits biofilm formation

Klebsiella pneumoniae (K. pneumoniae), especially serotype K57, is a major pathogen in dairy bovine mastitis, causing significant economic losses and posing a public health risk through contaminated dairy products. In addition, K57 is highly virulent among serotypes infecting humans, leading to serious conditions such as pyogenic liver abscess. In this study, we isolated and identified a bacteriophage called vB_Kp_Z57 that targets K57 serotype K. pneumoniae isolates from human and bovine sources. The phage has a latent period of 4 min and can produce approximately 233 phages per infected bacterial cell. vB_Kp_Z57 is stable over a temperature range of 4 °C to 60 °C and a pH range of 5–11. Sequencing and assembly of the phage genome revealed DNA molecules consisting of 40,316 base pairs. After genome annotation with bioinformatics software, it was discovered that the phage genome encodes 48 proteins, with no detected lysogeny genes, toxin genes, or tRNA-related genes. vB_Kp_Z57 was classified as a member of genus Przondovirus, family Autographiviridae. The results of bacteriostatic experiments show that vB_Kp_Z57 has a good effect on inhibiting bacterial growth. Notably, vB_Kp_Z57 significantly inhibited the growth of its host bacteria in milk at refrigerated temperatures of 4 °C and room temperature. Biofilm inhibition experiments revealed that phage vB_Kp_Z57 significantly reduced OD595 values in all phage-treated groups, indicating its potential as an effective biocontrol agent against K. pneumoniae. Our findings show the promise of vB_Kp_Z57 as a novel and environmentally friendly solution to address the challenges associated with K. pneumoniae in dairy production.

Successful Multidisciplinary Treatment of Severe Pyogenic Liver Abscess Caused by Fish Bone: A Case Report

Successful Multidisciplinary Treatment of Severe Pyogenic Liver Abscess Caused by Fish Bone: A Case Report

Extra Pulmonary Tuberculosis Manifesting as Liver Abscess

Extra Pulmonary Tuberculosis Manifesting as Liver Abscess

A case of amebiasis with multiple liver abscesses: A way to diagnosis

Amebiasis is a protozoal disease common for tropical countries. It is not frequently diagnosed in Central Russia, and is mainly seen in travelers, people with immunodeficiency, as well as in men who have sex with men. The main manifestation of the disease is intestinal damage with the development of diarrhea. With the hematogenic spread of the pathogen, extra-intestinal lesions of different organs may develop with the formation of abscesses in them. The liver, lungs, brain, and skin are most often involved in the inflammatory process. In this article, we describe a case of extrahepatic amebiasis with multiple liver abscesses, which presented difficulties in diagnosis. We provide details of observation and key laboratory findings as well as results of radiological examinations. Appearance of imported amebiasis in the Moscow region proves its actual importance and significance of timely diagnosis and etiotropic therapy. The aim of the article is to draw attention to the problem of diagnosis and prophylaxis of amebiasis in Central Russia as a result of migration and tourism to endemic territories.