Outcome Of Liver Abscess Research Articles

Epidemiology and factors associated with amoebic liver abscess at a tertiary care hospital in Northern India

Liver abscess is a collection of purulent material in the liver most commonly seen in the tropical countries. It can sometimes lead to significant morbidity and mortality if not treated timely and adequately. Through this study we wish to put light upon the current status of clinical aspects, laboratory features, and outcomes of liver abscess. The study was conducted at a tertiary care hospital in Northern India in the period of August 2020 to July 2021. All patients diagnosed with liver abscess of size >5 cm or left lobe liver abscess of any size were included in the study. All relevant laboratory investigations were conducted. The outcomes were noted and data was entered in MS Excel sheet. Analysis was done using SPSS version 26. Sixty-three patients were included in the study. A male predominance was noted. Mean age at presentation was 37.8 years. Most patients were part of the lower socioeconomic class. Pain abdomen and fever were the most common presenting symptoms. Amoebic liver abscess was much more frequently seen than pyogenic liver abscess. Deranged coagulation profile was seen in 88.9% patients. 85.7% patients were amenable to treatment with minimal intervention. Mortality as an outcome was seen in 9.5% patients Significant correlation was found between various laboratory parameters and outcomes such as length of hospital stay and mortality. Early diagnosis and treatment is crucial in management of patients with liver abscess even today.

The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization.

Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of thesepatients. From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%,respectively. Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.

Management and the Outcome of Liver Abscess, a Single Reference Experience in United Arab Emirates

Management and the Outcome of Liver Abscess, a Single Reference Experience in United Arab Emirates

Epidemiology, Clinical Features, and Outcome of Liver Abscess: A Single-Center Experience.

Introduction Liver abscesses are rare, but whenever they occur, it is predominantly among males over 60 years of age.The paradigm in the treatment has changed, and percutaneous drainage is now the initial treatment for drainage of the abscesses. Open surgery is reserved for patients with septated abscesses and those greater than 5 cm. Objective To study the etiological, clinical, pathological, and demographic characteristics of individuals with liver abscesses and to evaluate the outcome associated with different treatment strategies. Methods This clinico-epidemiological study was carried out at a tertiary care hospital in Jodhpur. One hundred patients with liver abscesses were studied.Patients were assigned to three groups: Group 1 - medical management alone (in non-aspirable uncomplicated abscess), Group 2 - USG-guided needle aspiration or pigtail percutaneous catheter drainage plus medical management (in unruptured aspirable abscess), Group 3 - open surgical drainage plus medical management (In ruptured abscesses). Of the total patients, 36% were treated with medical therapy alone, 45% with USG-guided needle aspiration, 10% with USG-guided percutaneous catheter drainage, and 9% with open surgical drainage. Results In our study, fever and hepatomegaly were the commonest presentations, observed in 91% and 62% of cases, respectively. Escherichia coli (E.coli) was the predominant organism cultured in 28 (43.75%) patients followed by Klebsiella growing in 24 (37.50%) patients. The right lobe was affected more (83%) than the left lobe and in the majority (83%), a solitary abscess was present. The mean age of liver abscess presentation was 40.72 years, with a 5.67:1 male-to-female ratio.Alcohol consumption was reported by 33% of patients, the majority of whom were men. Serum bilirubin was elevated in 56% of liver abscess patients, while it was normal in 44%. The mean serumbilirubin was 2.08 mg/dl. The mean value in group 1, group 2, and group 3 was 1.44 mg/dl, 2.23 mg/dl, and 2.57 mg/dl, respectively. Liver abscesses were identified in 76% of patients with right lobes; 83% had solitary liver abscesses and 17% had numerous abscesses. Abscess culture showed E. coli in 21 (32.81%) and Klebsiella in 17 (26.56%) patients. Conclusion Right-sided solitary pyogenic liver abscess caused by E.coli is the most common liver abscess, with fever and hepatomegaly as the most common presentation. Non-aspirable liver abscesses, regardless of aetiology, can be successfully treated by medical therapy alone. Needle aspiration or catheter drainage is standard for liver abscesses. Thus, needle aspiration has replaced the surgical exploration of liver abscesses.

BIOCHEMICAL MARKERS IN LIVER ABSCESS AND THEIR SIGNIFICANCE

Introduction: A liver abscess is a suppurative cavity in the liver resulting from the invasion and multiplication of microorganisms, entering directly from an injury, through the blood vessels or by the way of the biliary ductal system. The present proposed study is aimed to assess the prognostic value of serum C-reactive protein, lactate dehydrogenase and gamma glutamyl transferase in the outcome of liver abscess. Methods: Serum Levels of C-reactive Protein (CRP), Lactate Dehydrogenase (LDH) and Gamma Glutamyl Transferase (GGT) were measured in 125 patients with sonographic evidence of liver abscess at the time of diagnosis and weekly thereafter till 2 weeks after fever subsided. Results: CRP value at the time of admission was generally high and values were higher in larger size abscesses, indicates severity of disease. Its value gradually decreased with treatment and resolution of liver abscess. LDH value at the time of admission was generally on higher side of normal limit but showed a decreasing pattern in response to treatment and resolution of abscess. GGTvalue at the time of admission was high and gradually its level has decreased with treatment and resolution of liver abscess. However, it remained above normal levels in patients with history of alcohol addiction. Conclusion: Higher value of CRP, LDH, GGT correlate with severity of liver abscess disease. These serum markers have prognostic signicance.

Presentation, demography and management of Liver abscess patients in a tertiary care hospital of India

Background: Liver abscess (LA) is a cause of significant morbidity and requires timely management to prevent fatality. Aim: To study the demographic features, clinical presentations, and outcomes of liver abscess in Northern India. Material and methods: A prospective observational study was conducted on consecutive liver abscess patients presenting to a tertiary care centre treated from August 1, 2017, to 31, December 2020. The study participants were followed up for a period of one year Demographic features, clinical presentation and outcome were recorded and analyzed. Results: There were 83 males and 4 females, with mean age of 39.67 ± 11.85 years (ranging 13 to 70 years). History of alcohol intake was present in 85% (74/87) patients. The presenting symptoms were right upper abdominal pain in 91.95% (80/87), fever in 87.36% (76/87), nausea and/or vomiting 82.76% (72/87) and jaundice in 10.34% (9/87) cases. The commonest identifiable cause was colitis (11.5%). Majority of cases had a single abscess with involvement of right lobe of the liver. Out of 87 patients, 21 were cured with medical management and 56 additionally with ultrasound-guided percutaneous needle aspiration and drainage. Open drainage was performed 10 patients, of which 4 died. Conclusion: Early diagnosis and prompt institution of appropriate therapy is imperative in the management of liver abscess. Open drainage should not be delayed in cases lacking response to conservative treatment.

Liver Abscess in Children-experience From a Single Tertiary Care Center of North India: Etiology, Clinical Profile and Predictors of Complications.

Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children. The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications. ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days. ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA.

A study of treatment outcomes of liver abscess in a rural tertiary care centre

A study of treatment outcomes of liver abscess in a rural tertiary care centre

LIVER ABSCESS IN CHILDREN WITH CLINICAL PROFILE AND OUTCOME

Introduction: Liver abscess (LA) in a disease in which there is involvement of involves collection of purulent material in liver parenchyma due to bacterial, parasitic, fungal or mixed infections. This is common in India and also it is 2nd highest incidence because of poor sanitation, overcrowding and inadequate nutrition. Nowadays liver abscess is growing rapidly in developing modern medicine, with the advent of many investigative procedures in diagnosis of abdominal diseases. Infection of intra abdominal abscesses and abdominal infections are main attention of the physician and to be the liver as the liver is the organ most important for the development of abscess as it is 48% of all the visceral abscesses. Liver abscess has a significant mortality rate in both developing and developed countries. It may cause complication of various intraabdominal infections; by hematogenous spread via portal vein from the gastrointestinal tract; or, may develop after traumatic injury to the liver. Common types of liver abscess are pyogenic and amoebic. In India cases of liver abscesses in children constitute more than 79 per 100,000 pediatric admissions below 12 years old. For unknown reasons male children are similar to the male adults and are affected by liver abscesses more than female children.&#x0D; Aim: The main aim of this study is to evaluate the clinical profile and outcome of liver abscess (LA).&#x0D; Material and methods: Total 30 patients with various age groups from 1years to 14 years of age group attending to Pediatrics department of this college were included for study. All the patients were evaluated for their complaints, possible predisposing factors, mode of diagnosis, interventions where there or not during their stay. Laboratory investigation like Microbiological analysis of the pus was done and on the basis of culture reports, changes in drug prescription as antibiotic treatment included ceftriaxone, amikacin and metronidazole in specific doses. According to the ultrasonography abdomen and the number and amount of abscess cavities intervention were done. Pre intervention liver functions like prothrombin concentration (PC), prothrombin time (PT) and international normalized ratio (INR) were also recorded.&#x0D; Results: During the period of study total 30 patients were included in this study. The mean age of patients was 6.2 years and age range was 3 -12 years. Male to female ratio was 1.5:1 patients shows the clinical features as fever, abdominal pain and abdominal distension. Maximum patients showed main complain as fever by 25 patients (83.3%) followed by abdominal pain (right hypochondrium) by 20 patients (66.7%) , abdominal distension by 5 patients(16.7%), Peritonnitis by 3 patients (10%) and Subacute intestinal obstruction by 2 patients (6.7%).&#x0D; Conclusion: In children liver abscess is an important cause for morbidity. Liver abscess should be suspected presenting with prolonged fever and pain in upper abdomen to the emergency department. For the diagnosis of liver abscess Ultrasonography is an easy, widely available non-invasive and cost effective investigation. If timely it is not cure it may lead to rupture and mortality. High index of suspicion, early screening and appropriate intervention in form customized management may raise good results.&#x0D; Keywords: Children, Liver abscess, Pyogenic liver abscess, Treatment

Epidemiologic Factors, Clinical Presentation, Causes, and Outcomes of Liver Abscess: A 35-Year Olmsted County Study.

ObjectiveTo report the changing incidence, clinical presentation, microbiologic spectrum, and outcomes of pyogenic liver abscess (PLA) in Olmsted County, Minnesota, over the past 35 years.Patients and MethodsThe Rochester Epidemiology Project was used to identify residents with PLA from January 1, 1980, through December 31, 2014. The study included all patients older than 18 years, with the diagnosis of PLA confirmed through radiographic review and microbiologic cultures.ResultsIn total, 72 patients received a diagnosis of PLA from 1980 through 2014. The age-adjusted incidence for men was 3.92 cases per 100,000 person-years (95% CI, 2.76-5.09 cases per 100,000 person-years) compared with 1.87 cases per 100,000 person-years (95% CI, 1.15-2.59 cases per 100,000 person-years) for women. Incidence was higher in the period from January 1, 2001, through December 31, 2014, than in the period from January 1, 1980, through December 31, 2000, for women (incidence rate ratio [IRR], 3.8; 95% CI, 1.43-10.09; P=.007) but not for men (IRR, 0.99; 95% CI, 0.55-1.76; P=.96). Fifteen additional patients had postintervention PLA (1980-2000: n=3 of 29 [10.3%] vs 2001-2015: n=12 of 58 [20.6%]). A significant association was seen between age- and sex-adjusted incidence rates of PLA and year of diagnosis (per year since 1980: IRR, 1.04; 95% CI, 1.02-1.07; P<.001) after including postintervention PLA. Streptococcus milleri was the most common organism identified (52.5%). Organisms with multidrug resistance were more common in the period from 2001 through 2014 than in the period from 1980 through 2000 (51% vs 14%; P=.005). The overall mortality rate of PLA was 16.8% (95% CI, 7.6%-25.0%) at 6 months.ConclusionThe incidence of PLA is increasing, probably because of increase in frequency of hepatobiliary interventions and organisms with multidrug resistance.

Percutaneous Drainage may not be Necessary in a Significant Subset of Patients with Complicated Liver Abscess

Background and Aims: Clinical outcomes of liver abscess are changing, even in South Asia, where parasitic infections are common. We wanted to capture this emerging spectrum in ‘‘real life’’ through assessment of clinical features, management strategies, and outcomes of a cohort of treated liver abscess patients at a single center. Methods: In this retrospective study of patients admitted to a referral institution between February 2010 and June 2014, patients with liver abscess, who had received prior treatment in another hospital and then been referred for complicated illness, were studied; their demographics, presentations, evolution, and outcomes were analyzed. Results: A total of 154 patients [males 109, 70.78%), mean age 43.71 16.49 years] were included in this study. Alcohol was the commonest (n = 36, 23.38%) predisposing factor, followed by biliary obstruction (n = 32, 20.78%) and diabetes (n = 17, 11.04%). The most common presenting features were fever, pain abdomen, and jaundice [143 (92.86%), 133 (86.36%) and 32 (20.78%) respectively]. Majority of patients (90, 58.44%) had solitary liver abscess, right lobe being commonest location (94, 61.04%). Median abscess volume was 180 mL (7–1524 mL); abscess rupture occurred in 21 (13.64%) cases, most commonly to subdiaphragmatic location (12/21). Overall, 97 (63%) patients required abscess drainage [single time aspiration 15 (15.46%), percutaneous indwelling catheter in 80 (82.47%), and surgical drainage in 2 (2.06%)]. Patients who required percutaneous drainage were mostly males, had higher abscess volumes, and were more frequently alcohol users and diabetics (data provided in table). Six (3.9%) of the patients died during study period. Higher bilirubin level, shortness of breath, higher volume of abscess, and requirement of surgery were more frequent in non-survivors. Conclusion: While large abscess, alcoholism, and diabetes were associated with increased need for catheter drainage; 37% can be treated by drug therapy alone. Careful selection of subjects for drainagemight avoid premature mortality in this benign condition.

Epidemiology, Clinical Features and Outcome of Liver Abscess: A single Reference Center Experience in Qatar.

To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar. A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from January 1, 2009, to December 31, 2010. Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture. In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 (91%) males and six (9%) females and their mean age was 47.4 ± 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 (79%) patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients (38%). The mean duration of hospitalization was 13.6 ± 8.1 days; the mean duration of antibiotic therapy was 34.7 ± 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 ± 4.1 days, mean duration of therapy was 11.8 ± 2.1 days, and all patients were cured. Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical intervention was unnecessary in almost all the cases.

Liver abscess in patients with cirrhosis of the liver: a 12-year experience.

Liver abscess is rare in patients with cirrhosis of the liver. The aim of this retrospective study was to investigate the incidence, clinical presentation, causal pathogens, and outcome of liver abscess in cirrhotic patients. We collected 21 liver abscess specimens (from 14 male patients and 7 female patients; Child A: B: C, 4: 7: 10) from 22,731 admissions of 6450 cirrhotic patients, from 1986 through 1998. The common clinical symptoms and signs included fever, chills, and abdominal tenderness. The major predisposing factors were biliary tract disease (52%) and diabetes mellitus (48%). The diagnosis rate with abdominal ultrasonography was 79%. Gram-negative aerobes were the predominant pathogens (Klebsiella pneumoniae, 66.7%; Escherichia coli, 23.8%), and occurred in 80% and 69% of blood and pus cultures, respectively, while 38% of cases showed polymicrobial pathogens. The location of the abscess was predominantly in the right lobe (71.4%), and 47.6% of patients had multiple abscesses. Six patients died (all with Child C cirrhosis). The overall mortality rate was 28.6% (6/21). The incidence of liver abscess in the cirrhotic patients was low, at 0.09% (21/22,731 admissions). The clinical presentations and pathogens were not different from those in noncirrhotic patients, except that in our cirrhotic patients, there was no significant difference in mortality between those with monomicrobial and those with polymicrobial abscess: nor was there a significant difference in mortality between those with single and those with multiple abscesses. The Child C patients were the high-risk group.