Pyogenic Liver Abscess Patients Research Articles

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.

Treatment and prognosis of pyogenic liver abscess

BackgroundThere are many combinations of treatments for pyogenic liver abscess (PLA). Different treatments are indicated for different clinical courses of PLA.AimsTo realize the current prevalence, clinical course, trend of treatment, and prognosis of pyogenic liver abscess (PLA) in Taiwan.MethodsWe retrospectively reviewed the medical records of 126 patients with PLA. We divided them into four groups: M, MD, MS, and MDS, represented as parenteral antibiotic only, parenteral antibiotic with drainage, parenteral antibiotic with surgical intervention, and parenteral antibiotic with surgical drainage. We analyzed data by commercial statistical software (SPSS for Windows, version 11.0, SPSS Ltd., Chicago, IL). We used Student’s t-test and χ2 test for statistical analyses, and significance was set at a p value less than 0.05.ResultsPLA patients who were treated only with parenteral antibiotics had early diagnosis of PLA with a mean fever period of 3.3 days (p = 0.043). Patients who needed surgical drainage were highly associated with shock presentation in the clinical course (35.7% versus 14.3%, p = 0.007).ConclusionThe earlier we can diagnose PLA, the shorter the patient's hospital stay (20.6 days) will be. In PLA patients with shock, a higher rate of surgical intervention is mandatory to save their lives.

Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study

No large-scale population-based study has ever been conducted to examine the relationship between cryptogenic pyogenic liver abscesses (PLA) and the subsequent risk of colorectal cancer. This study aimed to estimate the risk for colorectal cancer following a diagnosis of cryptogenic PLA over a 5-year period. The study group comprised 274 patients who visited an outpatient care centre or were hospitalized with a diagnosis of cryptogenic PLA between 2001 and 2003. The comparison group included 1370 randomly selected subjects. Cox proportional hazard regressions were performed to compare the 5-year colorectal cancer-free survival rates for these two groups. Of the total sample, 40 patients from the study group (2.43%) had colorectal cancer during the 5-year follow-up period: 15 (5.45% of those with cryptogenic PLA) and 25 from the comparison group (1.82% of the comparison group). After adjusting for patients' age, sex, monthly income, level of urbanization and geographical location, the hazard of colorectal cancer during the 5-year period was 3.36 times greater for patients with cryptogenic PLA than for the comparison group [95% confidence interval (CI)=1.72-6.56, P<0.001]. The adjusted hazard of colorectal cancer during the 5-year follow-up period was 5.54 times higher for cryptogetic PLA patients with diabetes (95% CI=2.11-14.56, P<0.001) than the comparison group and 2.64 times higher among PLA patients without diabetes (95% CI=1.19-5.85, P<0.05). We conclude that cryptogenic PLA is an alarm that may signal colorectal cancer, especially among female patients with diabetes.

Pyogenic liver abscess: Differences in etiology and treatment in Southeast Asia and Central Europe

Knowledge of etiology and timely treatment of underlying causes, when possible, play an important role in the successful therapy of patients with pyogenic liver abscess (PLA). Recent publications from Central Europe and Southeast Asia hint at considerable differences in etiology. In this article, we aim to elaborate these differences and their therapeutic implications. Apart from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA), there are clear differences in the microbiological spectrum, which implies different risk factors and disease courses. Klebsiella pneumoniae (K. pneumoniae) PLA is predominantly seen in Southeast Asia, whereas, in Central Europe, PLA is typically caused by Escherichia coli, Streptococcus or Staphylococcus, and these patients are more likely to be older and to have a biliary abnormality or malignancy. K. pneumoniae patients are more likely to have diabetes mellitus. Control of septic spread is crucial in K. pneumoniae patients, whereas treatment of the underlying diseases is decisive in many Central European PLA patients.

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...

Severity of disease as main predictor for mortality in patients with pyogenic liver abscess

Background The purpose of this study was to explore the relationship between severity of illness at admission and mortality of patients with pyogenic liver abscess (PLA). Methods Medical records from 298 PLA patients ≥18 years old were reviewed. Severity of illness at admission was evaluated with the Acute Physiology and Chronic Health Evaluation (APACHE) II and the simplified acute physiology score (SAPS) II scoring systems. Stepwise logistic regression and receiver-operating-characteristic curve analyses were performed. Results The case-fatality rate was 10%. Multivariate analysis showed that APACHE II ( P = .0004), SAPS II ( P = .0008), the presence of gas-forming abscess ( P <.0001), and the presence of anaerobic infection ( P <.0001) all were associated with mortality. The area under the receiver-operating-characteristic curve was .884 (95% confidence interval .842 to .918) for APACHE II and .857 (95% confidence interval .812 to .895) for SAPS II, which were not significantly different ( P = .490). The optimal cutoff APACHE II value of ≥15 had a sensitivity of 77% and a specificity of 92%, with a 20.3-fold risk of mortality ( P <.0001). The SAPS II cutoff value of ≥28 had a sensitivity of 74% and a specificity of 82%, with a 7.2-fold risk of mortality ( P = .008). Conclusions Both the APACHE II and the SAPS II scoring methods are appropriate for assessing mortality of PLA patients.

Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors

pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons. to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients. retrospective chart review of all PLA patients between July 1999 and June 2007. a 1,600-bed primary and tertiary care centre. in total, 339 patients were enrolled and included 118 > or =65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group). clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates. the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission > or =15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients. these data suggest that older PLA patients would have a fair outcome compared to younger patients, but require longer hospitalisations.

Pyogenic Liver Abscess Associated with Septic Pulmonary Embolism

Septic pulmonary embolism (SPE) is one of the metastatic foci of pyogenic liver abscess. The purpose of this study was to investigate the clinical presentations of, and management options for patients with pyogenic liver abscess complicated with SPE. A retrospective chart review was conducted from January 1, 1999 to December 31, 2005 inclusively, in a medical center in northern Taiwan. We collected and analyzed the clinical presentations, diagnostic modalities, treatment programs and prognoses for all pyogenic liver abscess patients with SPE. The association between liver abscess affected with the complication of SPE and diabetes mellitus was significant. There were 9 patients who had pyogenic liver abscess with SPE. Abnormal chest radiograph (CXR) findings with multiple ill-defined peripheral round densities were noted in all patients. Seven patients were diabetic, fever occurred in 5 patients, respiratory symptoms were noted in 6 patients, and abdominal pain occurred in 3 patients. Endophthalmitis coexisted in 3 patients, meningitis in 1 patient, and necrotizing fasciitis in 2 patients. Microbiological studies revealed Klebsiella pneumoniae in 9 patients. Computed tomography (CT) demonstrated metastatic nodules in both lung lobes, some of which featured cavitation, in all 9 patients. Three patients soon advanced to acute respiratory failure, and later died due to acute respiratory distress syndrome and/or septic shock. The remaining 6 patients survived without complication during their hospital course. There is diagnostic value in performing a chest CT scan in diabetic patients who have liver abscess plus abnormal CXR findings with multiple ill-defined peripheral round densities, in order to detect SPE, which has a relatively poor outcome in patients with liver abscess.

Clinical Features of 141 Cases of Pyogenic Liver Abscess Over a 10-year Period and Antibiotic Sensitivity to the Causative Organisms

Background : Pyogenic liver abscess is an acute infectious disease caused by bacteria and can become severe and potentially life-threatening, with a mortality rate of 6-18%. The purpose of this study is to provide the basic informations for the management of liver abscess and the choice of the most effective and economic antibiotics. Materials and Methods :We investigated clinical, laboratory, radiologic findings and the results of bacteriological studies retrospectively by reviewing the medical records of 141 cases of pyogenic liver abscess patients, admitted to Catholic University St Vincent's Hospital from January 1998 to December 2007. Results :Patients demographics revealed a mean age of 57.1, (age: 18 to 87), and 71 of the 141 patients were male (50.4%). Cure was achieved in 51 (98.1%) of the 52 patients who were treated with the combination of percutaneous drainage and antibiotics, and in 80 (90.0%) of 89 patients who were treated only with antibiotics. However, there were no significant differences in mortality (P=0.092) and the time to defervescence between both groups. The mean duration of percutaneous drainage was 15.8±9.7 days. Sixty-four of 141 patients showed positive culture results, and K. pneumoniae (70.3%) was the most common organism. Among 45 K. pneumoniae, the rates of resistance were 73.3% to ampicillin, 66.7% to piperacillin, 8.9% to cefazolin, 2.2% to cefuroxime, 0% to ceftriaxone, and 0% to ciprofloxacin. Conclusions :Combination treatment of intravenous antibiotics and percutaneous drainage was effective for the treatment of pyogenic liver abscess. Initial broad spectrum antibiotic coverage and then switch to first or second cephalosporin according to the susceptibility results, could be recommended especially in patients with monomicrobial K. pneumoniae liver abscess.

Value of platelet count in the prognosis of patients with pyogenic liver abscess

AIM: To study the relationship between platelet count and the prognosis of patients with pyogenic liver abscess. METHODS: A total of patients with pyogenic liver abscess were diagnosed by computed to- mography (CT), magnetic resonance imaging (MRI) and liver punctures, and the average fo- cus size was 6.54 cm in diameter. Blood routine examination was performed everyday, com- bined with B-ultrasonography every three days. The relationship between the dynamic changes of platelet count and the prognosis of pyogenic liver abscess patients was analyzed. RESULTS: Within one week, 43 (38.39%) pa- tients were found with maximal platelet count more than or equal to 400 × 109/L, and 22 patients (19.64%) with platelet count less than 400 × 109/L. More than one week, 29 patients (25.89%) were with maximal platelet count more than or equal to 400 × 109/L, 18 patients (16.07%) with plate- let count less than 400 × 109/L. Thrombocytosis occurred quickly in the patients in hospital less than one week, whose maximal platelet countwas more than or equal to 400 × 109/L, and their clinical symptoms were improved remarkably as compared with those of patients in hospital more than one week, with maximal platelet count less than 400 × 109/L (P 0.05). CONCLUSION: Pyogenic liver abscess patients, in whom thrombocytosis occurs in short time, have a favorable prognosis. Blood count is an important indicator for the prognosis of Pyo- genic liver abscess.

Computed Tomographic Differences of Pyogenic Liver Abscesses Caused by Klebsiella pneumoniae and non-Klebsiella pneumoniae

To investigate the distinctive computed tomographic(CT) features of pyogenic liver abscess (PLA) caused by Klebsiella pneumoniae (KLA). 114 PLA patients (62 men, 52 women, age range 25-89 years, mean age 60.9 years) with positive yield of blood or pus cultures were divided into 2 groups; KLA group (n = 58) and non-KLA group (n = 56). We retrospectively reviewed the CT images. The independent-sample t-test, X2 test, or Fisher's exact test were used with SPSS for windows version 11.0. Gas formation showed no significant difference between two groups (P = 0.284), but air-fluid pattern was found only in KLA group (P = 0.027). The rim on dynamic CT was showed less frequently in KLA group than non-KLA group (P < 0.001), and smooth and regular rim was more common in non-KLA group (P < 0.001). The septation and septal breakage were more common in KLA group (P < 0.001). The turquoise sign was found significantly more in KLA group (P < 0.001). The hairball sign was detected only in KLA group (P < 0.001). The cluster sign was less frequent in KLA group (P < 0.001). KLA had a series of characteristic intra-abscess features; septal breakage, turquoise-like structure, hairball-like content, air-fluid level, and no enhanced rim. When turquoise/hairball sign or air-fluid level is present in abscess, KLA would be a probable diagnosis in the clinical field.

Pyogenic Liver Abscess in ESRD Patients Undergoing Maintenance Dialysis Therapy

Patients with end-stage renal disease (ESRD) on dialysis therapy have increased susceptibility to bacterial infection. Data regarding pyogenic liver abscess in this population are rare. We retrospectively examined all cases of pyogenic liver abscess in patients undergoing maintenance dialysis therapy in 2 tertiary referral centers. Medical records of patients with ESRD with a pyogenic liver abscess from January 1995 to September 2004 were studied. Twenty-seven of 20,676 admitted patients with ESRD were found to have a pyogenic liver abscess. The major predisposing factor was diabetes mellitus (59.3%). The most common clinical symptoms were fever and chills (85.2%). A rare presentation of hiccup was noted in 2 peritoneal dialysis patients, and endophthalmitis was noted in 2 patients with liver abscess caused by Klebsiella pneumoniae. Abscesses were located mainly in the right lobe (70.4%) and presented as a solitary mass (74.1%). K pneumoniae was the most common bacteria isolated in blood cultures (51.9%) and liver abscess aspirates (37%). Invasive drainage approaches performed in 17 patients (63%) resulted in a unique complication of peritonitis in 4 peritoneal dialysis patients. The difference in mortality rates between patients who underwent invasive procedures and those who did not was not significant (P = 0.68). The overall in-hospital mortality rate of patients with ESRD with a pyogenic liver abscess was 33.3%. Although pyogenic liver abscess is uncommon in patients with ESRD undergoing maintenance dialysis therapy, it is still a disease of significant mortality.

Pyogenic liver abscess in patients with schistosomiasis mansoni

Schistosomiasis mansoni has been described as a predisposing factor for pyogenic liver abscess formation. Previous experimental studies have shown that acute schistosomiasis concurrent with Staphylococcus aureus bacteremia favors the colonization of the liver by the bacteria, and subsequent pyogenic liver abscess formation. In addition, clinical studies and case reports have demonstrated the association of schistosomiasis mansoni with pyogenic liver abscesses. We describe a Brazilian patient with chronic schistosomiasis mansoni who developed recurrent pyogenic liver abscesses due to Pseudomonas aeruginosa. The authors review the clinical, diagnostic and treatment aspects of patients with schistosomiasis and pyogenic liver abscess reported in the medical literature.

A note on clinical presentations of amebic liver abscess: an overview from 62 Thai patients.

BackgroundAmebic liver abscess is a tropical disease with a wide spectrum of clinical presentations. Given the often nonspecific nature of the complaints related to amebic abscess, a retrospective review of patients with confirmed disease to recognize the most common patterns of presentation is useful. Here, we study the clinical presentations of 62 Thai patients with amebic liver abscess. We also compare the clinical presentations of Anti HIV seronegative and Anti HIV seropositive patients.MethodsA retrospective case review was carried out for 62 Thai patients who had been diagnosed with amebic liver abscess. Clinical information was collected, including symptoms and signs, location and number of abscesses. The Anti HIV serology laboratory investigation was also reviewed.ResultsAccording to our study, the common clinical symptoms and signs are abdominal pain (85.5 %), fever and chills (74.2 %), and abdominal tenderness (69.4 %). The location of the abscess was predominantly in the right lobe (74.2 %), and most of patients had a single abscess (77.4 %). Similar trends in clinical presentations were observed in both Anti HIV seropositive and Anti HIV seronegative subjects.ConclusionsIn conclusion, the clinical presentations of our amebic liver abscess patients were similar to those in previous reports. A similarity to those in the pyogenic liver abscess patients can be observed. Nevertheless, we could not detect important significant differences in the clinical presentations between Anti HIV seropositive and Anti HIV seronegative groups of patients.

Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark

BACKGROUNDPatients with liver cirrhosis are at increased risk of serious bacterial infections carrying a high case fatality rate. Case reports have suggested an association between liver cirrhosis and pyogenic liver...

Abscesos hepáticos piógenos en pacientes con cáncer

To analyse the clinical behaviour of pyogenic liver abscesses among cancer patients, and to determine whether there is any difference between clinical behaviour among patients without malignancies. Retrospective, multicentric study with 133 patients with pyogenic liver abscesses diagnosed during 13 years. Patients were divided into two groups: 29 patients with malignant tumors identified during the five years prior to abscess development (group 1) and 104 patients without malignant tumors (group 2). Clinical, biological and bacteriological findings, morphology and lesional topography, treatment and particularly, clinical course were analysed. Abscesses with portal pathogenesis were more common in group 1 (24% versus 10%; p = 0.03). Clinical and biological data were similar in both group but jaundice (31% versus 18%; p = 0.09), liver enlargement (38% versus 21%; p = 0.06) and pleural effusion (48% versus 28%; p = 0.03), which were more common in group 1. In the same group, the mean AST level was also higher (112 149 versus 60 88; p = 0.07 ). Morphology and lesional topography, as well as bacteriology in both groups did not differ significantly. In group 1, surgical drainage was performed less frequently (21% versus 38%; p = 0.09) and mortality rate was higher (24% versus 11%; p = 0.08). Nevertheless, no significant differences were observed between hospital stay and morbidity. Among patients treated with antibiotics only, the mortality rate was higher in group 1 (50% versus 10%; p = 0.06). In pyogenic liver abscess in patients with malignant tumor disease a predominance of portal pathogenesis was observed. The presence of cancer among patients with pyogenic liver abscesses did not imply a significantly different clinical presentation; however, the clinical course was worse than that observed in cases without cancer.

Intestinal nematodes, Toxocara infection, and pyogenic liver abscess in children: a possible association.

Eosinophilia and intestinal helminths are frequent in children with pyogenic liver abscess (PLA) diagnosed in Vitória (Brazil). For these reasons we hypothesized that nematode infection with larvae migrating through the tissues (Ascaris, Strongyloides, Ancylostoma, Necator and Toxocara) may be a predisposing factor for PLA in children. We compared the prevalence of intestinal helminth and Toxocara infection between children with PLA and a control group of children with no evidence of PLA at the Children's Hospital N.S. da Glória in Vitória. From October 1996 to February 1998, 13 children with PLA and 110 children with diseases other than PLA provided five stool samples (Hoffman, Baerman and Kato-Katz methods) and one blood sample for anti-Toxocara antibodies (ELISA IgG, with previous adsorption with Ascaris suum antigen). All PLA and comparison children belonged to a low socioeconomic class and lived in similar conditions. The frequency of intestinal nematodes and anti-Toxocara antibodies were significantly higher in PLA patients than in controls (intestinal helminths: 10/13 or 76.9 per cent in PLA cases and 31/110 or 28.1 per cent in controls; OR = 8.94; 95 per cent confidence interval (CI): 1.97 < OR < 50.06; anti-Toxocara antibodies: 9/13 or 69.2 per cent in PLA and 31/110 or 28.1 per cent in controls; OR = 6.59; 95 per cent CI: 1.65 < OR < 31.05). Moreover, the degree of eosinophilia was higher in PLA patients. Malnutrition was present in both groups. Hemoglobin was 9.5 g/dl in PLA patients and 9.7 g/dl in controls; p = 0.900. Serum levels of IgA and IgM were normal or above normal, with no difference between the two groups, but the levels of IgG and IgE were higher in PLA patients. Although there is some missing data in respect to some socioeconomic parameters in affected and comparison groups. these results support the hypothesis that helminth infection with larvae migrating through tissues may be a predisposing factor for PLA in children. Th2 cell activation and downregulation of Th1 cells, induced by helminths, thus reducing the microbicidal activity of phagocytes, as well as the granulomatous reaction around the larvae (mainly of Toxocara sp.) causing the trapping of bacteria in liver, may be possible explanations for the increased risk for PLA in children with intestinal nematodes and/or Toxocara infection.

Pyogenic liver abscesses in patients with malignant disease: a report of 52 cases treated at a single institution.

Prognosis of pyogenic liver abscesses in patients with malignant disease is generally considered poor. The discrepancy between the outcomes of liver abscesses caused by hepatopancreatobiliary malignant disease and those caused by other malignant diseases, however, to our knowledge has never been investigated. To clarify the clinical course of pyogenic liver abscess in patients with different types of cancer, and to compare outcomes in abscesses caused by hepatopancreatobiliary malignant disease and other malignant disease. Retrospective review of case series in our experience from 1980 through 1993. Tertiary care university teaching hospital. Fifty-two patients with pyogenic liver abscess related to the underlying cancer were divided into 2 groups. Group 1 (n=32) was composed of patients with cancer originating from the hepatic parenchyma, bile duct, and pancreas; group 2 (n=20) was composed of patients with cancer originating from other sites. Parenteral antibiotics, percutaneous drainage, surgical drainage, or hepatectomy, in combinations, were employed. Patient characteristics, symptoms, laboratory data, abscess characteristics, microbiological study, management, and outcome of the 2 groups were analyzed. Thirteen patients (41%) in group 1 and 16 patients (80%) in group 2 had undergone prior anticancer treatment. Jaundice was encountered more often in group 1 than in group 2 (29 patients [91%] vs 6 patients [30%], respectively, P=.001), whereas nausea and vomiting were more frequently seen in group 2 than in group 1 (17 patients [52%] vs 6 patients[31%], respectively, P=.04). Leukocytosis, hypoalbuminemia, hyperbilirubinemia, and reversed albumin-globulin ratio were more pronounced in group 1 than in group 2 (P=.001, .02, .003, and .03, respectively). Abscesses communicating with the intrahepatic biliary tree were more frequently encountered in group 1 than in group 2 (11 patients [34%] vs 2 patients [10%], respectively, P=.03). Escherichia coli and Klebsiella pneumoniae predominated in group 1, while the bacteria species in group 2 were more diverse. The hospital mortality rates of group 1 and group 2 were 28% (9 of 32 patients) vs 10% (2 of 20 patients) (P=.04), respectively. Twenty-three patients (72%) of group 1 died of uncontrolled biliary sepsis or progressive cancer or both within 6 months after the diagnosis, while 17 patients (85%) of group 2 survived longer than 1 year without relapse of the abscess and continued with anticancer treatment. Pyogenic liver abscess could be a presentation of hepatopancreatobiliary malignant disease at the preterminal stage, and carries a grave prognosis. Pyogenic liver abscess in patients with nonhepatopancreatobiliary malignant disease has a better chance of favorable outcome.