Pyogenic Liver Abscess Research Articles

Population-based cohort study investigating the association between weight loss and pyogenic liver abscesses

Population-based cohort study investigating the association between weight loss and pyogenic liver abscesses

Association between oral corticosteroid use and pyogenic liver abscesses in a case-control study

Association between oral corticosteroid use and pyogenic liver abscesses in a case-control study

Herpes zoster correlates with pyogenic liver abscesses in Taiwan

Herpes zoster correlates with pyogenic liver abscesses in Taiwan

Rapid diagnosis of culture-negative Klebsiella pneumoniae liver abscesses by next-generation sequencing: A case series

Diagnosis of Klebsiella pneumoniae (Kp) pyogenic liver abscesses is usually achieved by imaging and isolation of the bacterium. However, when blood and other cultures were negative, laboratory diagnosis of Kp liver abscess may be challenging. Herein we report two patients with culture-negative Kp liver abscess with atypical presentations diagnosed by metagenomic next-generation sequencing (mNGS). For the first non-diabetic patient, computed tomography examination of the abdomen showed multiple round low-density foci with untidy margin in the liver, which mimicked hydatid cysts; while the second patient presented with acute cholecystitis/cholangitis. mNGS analysis of the blood sample from the first patient revealed 144 sequence reads of Kp; and that of the second revealed 153 sequence reads of Kp as well as other latent or non-pathogenic microorganisms. Both patients responded promptly to antibiotics treatment. mNGS is a useful tool for laboratory diagnosis of culture-negative Kp liver abscess.

Fishbone penetration leading to pyogenic liver abscess: A case report.

The incidence of pyogenic liver abscesses (PLAs) resulting from foreign body ingestion is relatively rare; however, it poses significant risks, necessitating timely diagnosis and intervention. This report presents an unusual case involving a 77-year-old female who developed a PLA following the ingestion of a fishbone. The patient was accurately diagnosed using high-resolution computed tomography-based three-dimensional reconstruction and subsequently underwent successful treatment through laparoscopic incision, drainage, and simultaneous removal of the fishbone.

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.

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.

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

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.

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.

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.

A Prospective Study on the Spectrum of Liver Abscess With Special Reference to Ruptured Abscess in a Tertiary Care Hospital.

Introduction Liver abscesses are one of the most concerning healthcare issues in Western countries, with a prevalence rate of three per 100,000. Although with the improvement in the socio-economic status and the health care system, its incidence has decreased in developed nations, pyogenic and amoebic liver abscesses are still high in resource-poor countries. Low socioeconomic conditions, improper hygiene, lack of awareness, and often a delay in diagnosis can lead to fatal complications and high mortality. Methods This prospective study was conducted in the Department of General Surgery, Calcutta National Medical College (CNMC) from 1st January 2019 to 31st August 2020 after obtaining approval from the Institute Ethical Committee (IRB no: EC-CNMC/2019/238/1). Patients over 10 years old with clinical and radiological features of liver abscesses were included in the study. Demographic, clinical, and treatment parameters were analyzed. Clinical and biochemical data were also compared statistically between ruptured and unruptured cases. Results Sixty patients with liver abscesses were included in the study. A pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were 28 and 32 cases, respectively. Most patients were between 21 and 40 years of age (53.3%, n=60), with male predominance (76.7%, n=60).The most common symptom was fever in both PLA (89.2%, n=28) and ALA (65.6%, n=32). Most abscesses were 5-10 cm in size (56.6%, n=60). Clinical parameters like pedal edema, ascites, respiratory distress, intercostal tenderness, and peritonitis were associated with ruptured abscesses. Biochemical parameters like low albumin raised total leucocyte count (TLC), increased prothrombin time, and large size of the abscess were predictors of ruptured abscess (p<0.001). Image-guided aspiration was performed in 14 patients (23.3%, n=60), and CT-guided percutaneous catheter drainage was done in 30 cases (50%, n=60). The most common organism isolated was E. coli. The ruptured abscess was diagnosed in six patients (10%, n=60). All ruptured abscesses required laparotomy and open surgical drainage. After three months of follow-up, a complete resolution of abscess cavities were seen in 38 patients (63.3%, n=60). Mortality in our study was 5 (8.3%, n=60). Conclusion Although modern diagnostic tools can efficiently diagnose liver abscesses, the identification of clinical features still has its place. Percutaneous catheter drainage is most commonly performed as a minimally invasive procedure without significant morbidity.Clinical suspicion of a ruptured liver abscess should be dealt without a delay. Improved hygiene and awareness can reduce its incidence, but early identification of clinical features, prompt diagnosis, and treatment can reduce mortality and morbidity.

S4643 Sigmoid Diverticulitis Presenting as Pyogenic Liver Abscess

S4643 Sigmoid Diverticulitis Presenting as Pyogenic Liver Abscess

S283 The Association Between Pyogenic Liver Abscess and Increased Incidence of Colorectal Cancer Across Age Groups and in Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review

S283 The Association Between Pyogenic Liver Abscess and Increased Incidence of Colorectal Cancer Across Age Groups and in Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review

S4538 Successful Treatment of a Multiloculated, Giant Pyogenic Liver Abscess Through Non-Operative Approach

S4538 Successful Treatment of a Multiloculated, Giant Pyogenic Liver Abscess Through Non-Operative Approach

S4345 Hidden Perils: Delayed Pyogenic Liver Abscess Diagnosis Leading to Severe Endogenous Endophthalmitis

S4345 Hidden Perils: Delayed Pyogenic Liver Abscess Diagnosis Leading to Severe Endogenous Endophthalmitis

Klebsiella liver phlegmon mimicking a solid liver tumour

AbstractIntroductionThis case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection.Case DescriptionThe patient in this case study is an 81‐year‐old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.DiscussionThe discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.ConclusionUltrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non‐homogenous terminology, can obfuscate the correct diagnosis.

The clinical significance of pyogenic liver abscess after transarterial chemoembolization or microwave ablation on malignant liver tumors: A retrospective study.

Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment.

Clinical utility of combined contrast-enhanced ultrasound and intracavitary contrast-enhanced ultrasound in the percutaneous treatment of pyogenic liver abscess

Aim: This study aimed to evaluate the utility of the combined use of contrast-enhanced ultrasound (CEUS) and intracavitary CEUS (IC-CEUS) with diluted SonoVue in the management of percutaneous treatment for pyogenic liver abscess (PLA). Methods: 36 patients (23 males, 13 females; mean age 64 ± 13.9 years) with 39 PLAs (mean size 7.6 ± 3.4 cm) were selected for percutaneous catheter drainage (PCD) and/or percutaneous needle aspiration (PNA). CEUS and IC-CEUS were employed during the interventional maneuver and follow-up during hospital stay in all cases. Results: 33 patients with 24 PLAs underwent PCD, 8 patients with 10 PLAs were treated with single or multiple PNA, and the combination of PCD and PNA was used in the remaining 5 cases. During the treatment planning phase, the combined use of CEUS and IC-CEUS affected therapeutic choices (e.g., drainage technique, additional therapeutic measures) in comparison with pre-operative imaging in 66.7% of patients. Throughout the follow-up period, CEUS and IC-CEUS facilitated monitoring of PLA evolution, providing crucial information, especially with IC-CEUS, on the optimal timing of catheter removal. No adverse events occurred after CEUS and IC-CEUS. Conclusions: The combination of CEUS and IC-CEUS proved to be a powerful and safe tool for tailoring US-guided percutaneous treatments to patients with PLA.

Prognostic risk factors for pyogenic liver abscess caused by Klebsiella pneumoniae

BackgroundPyogenic liver abscess (PLA) caused by Klebsiella pneumoniae can vary in severity, and several risk factors for the development of organ dysfunction in PLA have been implicated. However, few studies to date have explored the most common risk factors for clinical severity.MethodsWe conducted a study on patients with PLA caused by Klebsiella pneumoniae between February 2013 and December 2022.Using logistic regression analysis, we sought to identify factors associated with positive blood culture, septic shock, and intensive care unit (ICU) admission.ResultsAfter included 200 patients, we found that an elevated procalcitonin (PCT) level (p = 0.03), higher glucose level (p = 0.03), and lower total cholesterol (TC) level (p = 0.01) were associated with a higher likelihood of positive blood bacteriological culture. Additionally, an increased PCT level (p = 0.02) and lower TC level (p < 0.01) were associated with an elevated risk of septic shock. Furthermore, a higher PCT level (p < 0.01) was associated with a higher probability of ICU admission.ConclusionIn patients with PLA caused by Klebsiella pneumoniae, the PCT, glucose, and TC levels were found to be associated with positive blood culture, septic shock, and ICU admission.