Liver Abscess Patients Research Articles

Klebsiella pneumoniae bacteremia and renosplenic abscesses without intestinal symptoms as the initial manifestations of non-steroidal anti-inflammatory drug-induced colitis: a rare case report

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs), the most widely prescribed drugs in the world, can cause gastrointestinal damage, including colitis. However, the prevalence of NSAID-induced colitis is unknown because the disease is often asymptomatic.Case presentationWe report the case of a 64-year-old female patient with a history of long-term NSAID use, who was hospitalized with septic shock caused by Klebsiella pneumoniae bacteremia. Computed tomography revealed multiple renal and splenic abscesses with diffuse colon wall thickening. A colonoscopy confirmed colitis with diffuse ulcers. NSAIDs were discontinued after this hospitalization. The abscesses improved after antibiotic treatment. A short course of balsalazide treatment was given under the suspicion of ulcerative colitis. Balsalazide was discontinued four months later due to a non-compatible clinical course. A follow-up colonoscopy two years later revealed a normal colon mucosa, and NSAID-induced colitis was diagnosed.ConclusionThis is the first reported case of combined bacterial splenic and renal abscesses without intestinal manifestations as the initial presentation of NSAID-induced colitis. In contrast to cases of K. pneumoniae bacteremia with primary liver abscesses in patients with diabetes mellitus in Taiwan, we presented the first case with abscesses caused by community-acquired K. pneumoniae in the kidneys and spleen without liver invasion. In conclusion, our case report alerts clinicians to the possibility that K. pneumoniae bacteremia combined with multiple abscesses can be associated with severe NSAID-induced colitis.

Community-acquired Klebsiella pneumoniae liver abscess: the London experience

We read with interest the case series and review of Klebsiella pneumoniae community-acquired liver abscesses in Ireland and Europe by Moore and colleagues [1]. While we would agree that K. pneumoniae is a significant microbiological cause of this disease, we question the incidence of K. pneumoniae bacteremia which results in communityacquired liver abscesses, and also whether K. pneumoniae or the Streptococcus anginosus group remain more commonly associated with this condition in the United Kingdom. Our area of practice encompasses a multi-site NHS Hospital Trust with three tertiary referral hospitals and a second NHS Trust with a single tertiary referral hospital, both in north-west London. These four hospitals accept acute adult admissions and provide services to a population approximating two million. We reviewed both positive K. pneumoniae and S. anginosus group bacteremias and also solicited consults to Clinical Infectious Diseases services relating to community-acquired liver abscesses. Amongst patients over 18 years of age, we found 207 K. pneumoniae bacteraemias over a 4 year period from 2009 to 2012 from the four tertiary referral hospitals. Of these, 162 had contemporaneous abdominal imaging with either ultrasonography or computerised tomography. Within those 162 cases, only 13 (8.0 %) had evidence of a liver abscess. Over the same period, we found 35 S. anginosus group bacteremias, of whom 27 had concomitant abdominal imaging with either ultrasonography or computerised tomography. While a numerically smaller cohort, we found six (22 %) confirmed community-acquired liver abscesses in this group, a rate almost three times that in our K. pneumoniae bacteremias. In the patients with S. anginosus group liver abscesses, imaging confirmed extrahepatic metastatic spread in all six of these patients, but only one of the 13 K. pneumoniae liver abscess patients. In the same north-west London cohort, Clinical Infectious Diseases services are offered and electronically recorded in two of these hospitals. Over the same period, from 2719 solicited consults we found a further 12 cases of community acquired liver abscesses, of which a causative organism was identified in 11. While K. pneumoniae was the causative pathogen in two cases, we found S. anginosus group a more frequent mono-microbial cause, being isolated in five patients. The remaining cases had Enterobacter cloacae (one case) or Escherichia coli (one case) isolated, or positive amoebic serology (two cases). Our case series of 15 K. pneumoniae communityacquired liver abscesses was reviewed—13 from bacteremic patients, two cases from Clinical Infectious Diseases consults (Table 1). Of these 15, we found that 13 were male, six had a diagnosis of diabetes mellitus and six had a history of travel to Asia, Africa or the Pacific region within the last 6 months. We found a mean age of 58 years. Fever was ubiquitous in their presentation, and eight of the 15 had abdominal pain as part of their symptomatology. This epidemiological data broadly supports that identified by Moore and colleagues, but in L. S. P. Moore (&) National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 0HS, UK e-mail: 1.moore@imperial.ac.uk

Chemoembolization and Radioembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) continues to represent a major worldwide problem. Although treatments such as resection, transplantation, and ablation may provide a chance for a cure, these options are often precluded because of advanced disease presentation. Palliative treatments include transarterial embolization and systemic therapies. This review will summarize the state of the science for embolic therapies in HCC (conventional and drug-eluting chemoembolization, radioembolization) as well as discuss related topics including HCC staging, assessment of response, and ongoing clinical trials.

Hyperbilirubinemia in Patients with Amoebic Liver Abscess: A Study of 75 Cases

Background: Hyperbilirubinemia is a frequent occurrence in patients with amoebic liver abscess (ALA). Despite this, the cause of jaundice has not been established. It is presumed to be either due to parenchymal destruction or due to cholestatis due to pressure on the intrahepatic bile ducts by the abscess cavity or a combination of both. Aim: The present study is designed to study the incidence and the cause of hyperbilirubinemia in patients with ALA. Settings and design: prospective randomized controlled study Methods and material: Study was performed in a tertiary care centre with high volume of patients of liver abscesses. We evaluated 75 patients of liver abscess from December 2008 to March 2010 and based on presence or absence of hyperbilirubinemia, divided into Group I (serum bilirubin ≥ 1 mg/dl) and Group II (serum bilirubin <1 mg/dl). After detailed evaluation, both the Groups were compared on basis of parameters like clinical symptoms (e.g. fever, pain), alcohol intake, leucocytosis, bilirubin levels, liver enzymes, size of cavity, and response to treatment. Statistical analysis used: Chi square test/ Fischer’s exact test was used for qualitative data, and for quantitative data, t-test/Mann Whitney test was used. Results: In this study, we found hyperbilirubinemia in 23 of total 75 ALA patients with incidence of 30.7%. Overall the serum bilirubin values ranged from 0.4 to 11.7 mg/dl (mean=1.551) whereas in group 1 it ranged from 1.3 to 11.7 mg/dl (mean=3.71). The high values of bilirubin were associated with elevated alkaline phosphatase enzyme in 21 of 23 cases (91.3%) however significant biliary radical dilatation could not be found. The Jaundice responded well to the drainage of abscess cavity. Conclusions: Hyperbilirubinemia occurs frequently in cases of amoebic liver abscess which seems to obstructive in nature and it can be treated by surgical drainage of the abscess cavity. Further large volume and more detailed studies are needed to confirm the findings.

A Case of Sudden Onset Septicemia in Recurred Gastric Cancer Following S1 Plus Docetaxel Treatment

Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.

To Study the Etiology and Various Treatment Modalities of Liver Abscess

Objective: study the etiology and various treatment modalities of liver a prospective study over a period of one year from November 2011 to October 2012 in the department of General surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu. (1) To study the etiology of liver abscess whether pyogenic or amoebic. (2) How many were treated conservatively and how many needed intervention either aspiration or pig tail catheter drainage or open surgical drainage. Materials and Method: The patients of this study were admitted from the emergency wing, indoor and outdoor department of surgery and medicine over a period of one year from November 2011 to October 2012 in the department of General surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu. Patients of all age groups and either gender who presented with clinical suspicion of liver abscess or already diagnosed were included in the study. Results: (1) Majority of the patients in our study had amoebic liver abscess (73.33%). (2) E.coli and Klebsella were the most common organisms cultured from the pyogenic abscess. (3) Majority of amoebic liver abscess patients were treated with drug therapy alone whereas all pyogenic liver abscesses required some form of drainage.

Evaluation of antigen detection and polymerase chain reaction for diagnosis of amoebic liver abscess in patients on anti-amoebic treatment.

BackgroundDiagnosis of amoebic liver abscess (ALA) in patients on anti-amoebic drugs is difficult. There is scanty data on this issue using Entamoeba histolytica (E. histolytica) lectin antigen and polymerase chain reaction (PCR). We studied utility of lectin antigen, PCR, and IgG antibody in diagnosis of liver abscess in patients on anti-amoebic treatment. Liver aspirate of 200 patients, of which 170 had anti-amoebic drug prior to drainage, was tested for E. histolytica lectin antigen by (ELISA), PCR, bacterial culture, and serum IgG antibody by (ELISA). Classification of abscesses was based on result of anti-amoebic IgG antibody and bacterial culture, E. histolytica PCR and bacterial culture, and E. histolytica lectin antigen and bacterial culture.FindingsUsing anti-amoebic IgG antibody and bacterial culture, 136/200 (68.0%) were classified as ALA, 12/200 (6.0%) as pyogenic liver abscess (PLA), 29/200 (14.5%) as mixed infection, and 23/200 (11.5%) remained unclassified. Using amoebic PCR and bacterial culture 151/200 (75.5%) were classified as ALA, 25/200 (12.5%) as PLA, 16/200 (8.0%) as mixed infection, and 8/200 (4.0%) remained unclassified. With E. histolytica lectin antigen and bacterial culture, 22/200 (11.0%) patients were classified as ALA, 39/200 (19.5%) as PLA, 2/200 (1.0%) as mixed infection, and 137/200 (68.5%) remained unclassified.ConclusionsE. histolytica lectin antigen was not suitable for classification of ALA patients who had prior anti-amoebic treatment. However, PCR may be used as alternative test to anti-amoebic antibody in diagnosis of ALA.

Metronidazole treatment for acute phase amoebic liver abscess in patients co-infected with HIV

Metronidazole is the drug of choice for invasive amoebiasis; however, it is not known whether its dose or duration require modification in HIV infection when treating invasive amoebiasis. Seven HIV-positive patients with acute phase amoebic liver abscess were treated with daily oral administration of 1500 mg of metronidazole for 10 days. None of the patients required abscess drainage, and metronidazole was effective in all patients without serious side-effects. The CD4 cell count or HIV viral load did not appear to influence the efficacy of metronidazole therapy.

Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer

BackgroundThe aim of this study was to identify predictors of treatment failure of percutaneous catheter drainage (PCD) in patients with hepatobiliary-pancreatic cancer with pyogenic liver abscess (PLA). MethodsMedical records of 44 patients with PLA with underlying hepatobiliary-pancreatic cancer who underwent PCD under computed tomographic guidance as primary treatment between January 2001 and December 2010 were collected and reviewed. Included patients were diagnosed with cholangiocarcinoma (n = 16), hepatocellular carcinoma (n = 12), pancreatic carcinoma (n = 9), carcinoma of the ampulla of Vater (n = 6), and gallbladder cancer (n = 1). The clinical factors related to failure of PCD were determined using logistic regression. ResultsThe median age of the 44 patients with PLA was 68 years, and 48% were men. PCD failed in 15 patients (34%). Of the 15 patients with PCD failure, 12 subsequently required surgical intervention because of either clinical deterioration or imaging that demonstrated failure of abscess resolution with PCD. Three of these patients died with the initial drain in place before resolution of the abscess. In patients requiring surgery after PCD failure, the frequency of cure or abscess resolution reached 67%. Fourteen patients (32%) died during hospitalization. Multivariate analysis identified that multiloculated abscesses (P = .005) and abscesses with biliary communication (P = .036) were associated with failure of PCD. ConclusionsMultiloculated abscesses and lesions with biliary communication pose a greater likelihood of failure of PCD in patients with hepatobiliary-pancreatic cancer with PLA. Early surgical intervention after PCD failure should be considered for these patients.

Are Pyogenic Liver Abscesses Still a Surgical Concern? A Western Experience

Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.

Clinical nursing care for liver abscess patients treated by indwelling drainage tube after puncture under ultrasonic guidance

Objective To discuss the clinical nursing care for liver abscess patients treated by indwelling drainage tube after puncture under ultrasonic guidance.Methods 64 liver abscess patients with diameter of the abscess longer than 5cm were treated by indwelling drainage tube after puncture under ultrasonic guidance,clinical nursing care was performed before and after the operation.Results The recovery rate of liver abscess treated by puncture was 100％,no complication occurred.Conclusions It is feasible for the liver abscess patients to perform puncture under ultrasonic guidance,and meticulous nursing is a pivotal measure to improve cure rate. Key words: Liver abscess; Percutaneous liver puncture; Nursing care

Molecular Typing and Virulence Analysis of Serotype K1 Klebsiella pneumoniae Strains Isolated from Liver Abscess Patients and Stool Samples from Noninfectious Subjects in Hong Kong, Singapore, and Taiwan

Serotype K1 Klebsiella pneumoniae with multilocus sequence type 23 (ST23) has been strongly associated with liver abscess in Taiwan. Few data regarding the strain types and virulence of this serotype from other Asian countries are available. Serotype K1 K. pneumoniae strains isolated from liver abscess and stool samples from subjects hospitalized in Hong Kong, Singapore, and Taiwan hospitals were examined. Forty-seven serotype K1 isolates were identified: 26 from liver abscess samples and 21 from stool samples. MLST revealed 7 sequence types: 85.1% (40 of 47 isolates) belonged to ST23, 1 isolate belonged to ST163 (a single-locus variant of ST23), and 2 isolates were ST249 (a 3-locus variant of ST23). New STs, namely, ST367, ST425, and ST426, were allocated to 3 of 4 isolates from stool samples. The virulence of these strains was determined by neutrophil phagocytosis and mouse infection models. Except for two ST23 isolates, all Klebsiella pneumoniae isolates were resistant to phagocytosis. Resistance to serum killing varied in isolates of ST23, while all non-ST23 strains were susceptible to serum killing except one with ST249 from a liver abscess. All hypervirulent isolates with a 50% lethal dose of <10(2) CFU were from ST23, were resistant to phagocytosis and serum killing, and also carried both virulence-associated genes, rmpA and aerobactin. Multilocus sequence typing genotype 23 was the most prevalent sequence type among serotype K1 K. pneumoniae isolates from both liver abscess and stool samples in the Asia Pacific region. Serotype K1 K. pneumoniae isolates with capsule expression leading to phagocytic resistance and with the aerobactin gene were associated with hypervirulence.

Liver abscess presentation and management in Saudi Arabia and the United Kingdom

BACKGROUND AND OBJECTIVES:Liver abscess (LA) is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom (UK).DESIGN AND SETTING:Retrospective review of LA patients from three tertiary care centers (2 from Saudi Arabia and 1 from the UK) over a period of 10 years, from 1995 to 2005.PATIENTS AND METHODS:Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome.RESULTS:A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean (SD) age was 45.2 (20.3) years for those from Saudi Arabia and 55.4 (18.8) years for those from the UK (P=.022). The majority of the patients were males (70% from Saudi Arabia and 80% from the UK). Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 (80%) patients. Organisms were isolated in 43 (52%) cases and the majority of these were coliforms (58%). Amebic liver abscesses occurred in 19 (23%) patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 (80%) patients with aspiration and/or antibiotics, and 9 (10.8%) patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome (P=.008, .029 and .001, respectively).CONCLUSIONS:Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas.

Abstract No. 313: Pasteurization of hepatic abscesses with RFA in immunocompromised patients with chronic granulomatous disease

To evaluate the clinical application and outcomes of radiofrequency ablation (RFA) of hepatic abscesses in patients with chronic granulomatous disease (CGD). Four CGD patients with a total of 22 liver abscesses were treated during 9 separate sessions of image guided RFA by open surgical (1 session) or percutaneous (8 sessions) access between 1999 and 2005. All patients signed informed consent for the procedure and were treated under a compassionate exemption mechanism. Liver abscesses in CGD patients typically develop into large fibrotic masses containing extensive granulomas and microabscesses causing them to be untreatable by conventional methods like tube drainage. Only patients for whom surgery was medically contraindicated or who refused surgery were eligible to undergo RFA. All liver abscesses treated with RFA were successfully eradicated by radiographic criteria, with the first 3 demonstrating microbiological inactivity following surgical resection (1 lesion) or biopsy (2 lesions) immediately following RFA. The rest of the treated lesions remained free of radiographic evidence for abscess from 1 to 77 months follow-up (mean of 40.7months). Three of 4 patients had liver abscesses clinically and radiographically eradicated, and were without acute or chronic complications. One patient developed septic shock during RFA, likely due to a toxin-producing organism, and died 36 days following RFA. Screening methods for the specific toxin-producing organism have been implemented prior to consideration for RFA in the patient population. RFA can successfully treat liver abscesses in patients with chronic granulomatous disease. Optimal drainage of pus or screening for specific bacterial exotoxins prior to liver abscess RFA might avoid RFA-related toxic shock-like syndrome.

Clinical and microbiological analysis of adult perianal abscess

In Taiwan, Klebsiella pneumoniae is the predominant pathogen causing pyogenic liver abscess in patients with diabetes mellitus (DM). The purpose of our hospital-based study was to determine the predominant bacterial species causing perianal abscess in hospitalized patients with and without DM in Taiwan. Data on patients admitted and then operated on for perianal abscess during the period of March 2001 to December 2008 were reviewed. Information extracted from medical records included clinical information and laboratory data as well as culture and antibiotic sensitivity results. A total of 183 patients underwent surgery for perianal abscess. The most common pathogen causing perianal abscess in non-DM patients was Escherichia coli (67.1%), and the most common pathogen isolated in DM patients was K pneumoniae (60%; p=0.009). Among the 25 patients with DM, incident DM was diagnosed in 24.0% (6 of 25). In addition, five patients had transient hyperglycemia. Escherichia coli was the predominant pathogen isolated from perianal abscesses in patients without DM. Klebsiella pneumoniae, however, was the predominant pathogen isolated in DM patients. In both DM and non-DM patients, more than 90% of K pneumoniae isolates showed in vitro sensitivity to first-generation cephalosporins.

Pyogenic Liver Abscess in the Elderly

We analyzed the characteristics of elderly patients with pyogenic liver abscess, including clinical features, laboratory analyses and outcomes. A retrospective review of patient records from January 1, 2007 to June 30, 2008, identified 140 cases of liver abscess hospitalized in a medical center in northern Taiwan. Patients transferred from other hospitals, or those who had amoebic, fungal, traumatic or iatrogenic LA were excluded, and 122 cases were enrolled. We divided patients into two groups: an elderly group aged ≥ 65 years, and a non-elderly group. We collected information on clinical manifestations, laboratory data, imaging, blood and pus culture, and surgical findings for statistical analyses. We compared the elderly and the non-elderly with pyogenic liver abscess with respect to diabetes history ( p = 0.03), presence of fever ( p = 0.19), days of fever before hospital visit ( p = 0.001), abdominal pain ( p = 0.08), diarrhea ( p = 0.36), shock ( p = 0.25), white blood cell count ( p = 0.70), serum glucose ( p = 0.49), aspartate aminotransferase ( p = 0.95), length of hospital stay ( p = 0.10), and mortality ( p = 0.12). Most positive results in cultures were for Klebsiella pneumoniae , and the positive rates in culture of blood and pus were 43% and 60%, respectively. We found that there was no significant statistical difference between elderly and non-elderly pyogenic liver abscess patients in the presence of fever, abdominal pain, diarrhea, shock, white blood cell count, serum glucose, aspartate aminotransferase, hospital stay, and mortality. The elderly pyogenic liver abscess patients had fewer days of fever before hospital visit (2.2 ± 2.2 vs. 6.3 ± 6.9; p = 0.001). The elderly were taken to hospital earlier, because their families were more concerned about their constitutional symptoms. More cases of diabetes in the elderly pyogenic liver abscess group (44.7% vs. 39.3%) may arise because of more diabetes in the elderly population.

Characteristics of Pyogenic Liver Abscess Patients With and Without Diabetes Mellitus

Pyogenic liver abscess (PLA) is relatively common in patients with diabetes mellitus (DM), but it is unclear whether there are differences between patients with and without DM. We conducted a study to identify the possible differences and factors that affect fatality. We included PLA patients treated at a medical center from April 2001 to March 2004 and compared the clinical characteristics of patients with and without DM. We applied chi-square, Fisher's exact, and t-tests to evaluate the differences between the two groups and used logistic regressions to identify predictors of fatality. Of the 377 patients included, 182 (48.3%) had DM. Patients with DM had higher prevalence rates of cryptogenic etiology, gas-forming nature, thrombocytopenia, hyperglycemia, growth of Klebsiella pneumonia in blood cultures, metastatic infection, and bacteremia, but lower prevalence rates of biliary origin, right upper quadrant pain, and growth of Escherichia coli in pus cultures. Whereas creatinine >1.3 mg/dl (adjusted odds ratio (OR) 7.3, 95% confidence interval (CI) 2.2-24.5) and gas-forming nature (adjusted OR 9.4, 95% CI 3.0-24.5) were predictors of fatality, DM was not. We discovered that C-reactive protein and neutrophil were good biomarkers of PLA, but not asparate aminotransferase and alanine aminotransferase. PLA patients with and without DM have different clinical characteristics, but DM is not a predictor of fatality. We have identified several biomarkers that might help reduce the misdiagnosis of PLA.

Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department

Background:Delayed diagnosis of pyogenic liver abscess remains a challenging problem in the emergency department because of the associated high morbidity and mortality.Objective:To evaluate the sensitivity of ultrasono-graphy in the diagnosis...

Long-term follow-up of pyogenic liver abscess by ultrasound

Background/aims To study the morphology of residual abscess in successfully treated pyogenic liver abscess by ultrasound. Methods 116 consecutive patients of liver abscess diagnosed from April 2004 to March 2007 were included in this study. Patients with amebic liver abscess were excluded. Patients were treated with antibiotics for 6 weeks and when indicated drained percutaneously. Ultrasound scan was repeated after 2 weeks, 1 month, 3 months, 6 months and 12 months of treatment. Thereafter it was repeated every 6 months. Results After exclusion, 102 patients with >150 lesions were studied. Diagnosis was made on the basis of clinical presentation, ultrasound examination and diagnostic aspiration. It was single in 83, double in 12 and more than 2 in seven patients. Size varied from 4.2 cm to 15 cm. Organisms were isolated in 29 patients ( E. coli 10, Kliebsiella sp. 6, S. aureus 5, Pseudomonas aeruginosa 2, Acenetobacter 1 and multiple growth 5) in blood and eight patients ( E. coli 5 and S. aureus 3 and multiple growth 2) in pus. Majority of abscess resolved sonologically after 2–18 weeks of treatment. Healing was delayed in alcoholic and diabetic patients. In eight patients there was residual abscess even after 104 weeks of follow-up. In four patients it healed with calcification. Conclusions Majority of pyogenic liver abscess resolve to normal parenchyma within 18 weeks time. However, some lesions may take longer time to heal even after successful treatment. It should be considered in differential diagnosis of space occupying lesion of the liver in ultrasound and need no therapeutic intervention.

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.