Pyogenic Liver Abscess Research Articles

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.

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.

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

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

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

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

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

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

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.

Implantable and wireless-controlled antibacterial patch for deep abscess eradication and therapeutic efficacy monitoring

Pyogenic abscesses in deep organs represent severe bacterial infections that can be life-threatening. Traditional photodynamic and sonodynamic hybrid therapy (PDT/SDT) faces various limitations when treating deep organ abscess, including difficulties in drug release control, limited penetration of external laser, a hypoxic microenvironment, and challenges in therapeutic efficacy monitoring. To address these issues, we developed an implantable and wireless-controlled antibacterial patch integrated with modules for on-demand drug release, light control and therapeutic efficacy monitoring, providing a comprehensive solution to the clinical challenges of PDT/SDT in treating deep organ abscess. This self-adhesive and miniaturized patch can easily attach to internal tissues, and be wirelessly powered and controlled by external ultrasound. Initially, ultrasound powered the patch’s drug release module through the lead zirconate titanate piezoelectric transducer (PZT), providing distinct electrical-thermal release signals for indocyanine green (ICG) and hemoglobin (Hb). This ensured that Hb was released first to generate oxygen, alleviating the hypoxic microenvironment at the infection site, followed by the release of ICG as both a photosensitizer and sonosensitizer. Subsequently, ultrasound directly activated the sonosensitizer and powered the µLEDs in the light control module, ultimately initiating SDT/PDT hybrid antibacterial treatment. The therapeutic efficacy monitoring module in the patch used hydrogels with infection detection capabilities to provide timely feedback on the treatment status of the infected lesions, enabling doctors to rapidly adjust treatment plans and significantly improve the flexibility and effectiveness of treatments. Both in vitro and in vivo experiments have demonstrated that the patch can completely cure pyogenic liver abscesses. This research also exhibits promise for extending the application of the patch to treat other types of deep infections.

Percutaneous Drainage Of Pyogenic Liver Abscess: A Case Series

Percutaneous Drainage Of Pyogenic Liver Abscess: A Case Series

Double trouble: an unusual case of Klebsiella pneumoniae invasive syndrome with liver abscess, gallbladder empyema and infective endocarditis

BackgroundKlebsiella pneumoniae invasive syndrome (KPIS) is characterized by primary pyogenic liver abscess associated with metastatic infections. Although rare, Klebsiella endocarditis carries a high mortality risk.Case presentationA 60-year-old lady with type II diabetes mellitus presented with fever, malaise, right hypochondriac pain and vomiting for two weeks. Ultrasound abdomen revealed a collection within liver, and distended gallbladder with echogenic debris within. 3 days after ultrasound guided pigtail drainage of gallbladder empyema, newly presence murmur detected. Pus, urine, and blood cultures obtained were positive for Klebsiella pneumonia. Echocardiogram exhibited oscillating mass attached to anterior mitral valve leaflet. After 6 weeks of intravenous ceftriaxone, follow-up echocardiogram and ultrasound showed complete resolution of mitral valve vegetation, hepatic and gallbladder collection.ConclusionConcomitant extrahepatic infective endocarditis (IE) should raise concerns in daily practice for patients with Klebsiella pneumoniae liver abscesses, despite the rarity of Klebsiella endocarditis. In the absence of diagnostic suspicion, antibiotic treatment regimens may be shortened, and adverse effects from IE infection may ensue.

Pyogenic liver abscess in pediatric populations in beijing (2008–2023)

BackgroundData on pyogenic liver abscess (PLA) of children in China have been limited. We aimed to summarize the clinical feather, microbiological characteristics, management, and outcome of PLA in children.MethodWe retrospectively reviewed PLA cases from January 2008 to June 2023 at Beijing Children’s Hospital. Clinical characteristics, pathogens and management were analyzed.ResultsWe diagnosed 57 PLA patients in our center. The median onset age was 4.5 years and the male-to-female ratio was 1.6:1. The median diagnostic time was nine days and the median length of stay was 22 days. Twenty-eight patients (49.1%) had predisposing factors, around 71.4% of the patients had malignant hematology and primary immunodeficiency disease. Patients with underlying factors were more likely to have extrahepatic organ involvement (p = 0.024), anemia (p < 0.001), single abscess (p = 0.042), unilateral involvement (p = 0.039), and small size of the abscess (p = 0.008). Twenty-four patients (42.1%) had extrahepatic organ involvement. Pathogens were identified in 17 patients (29.8%), the most common pathogens were Klebsiella pneumoniae and Staphylococcus aureus. The positive rate of metagenomic next-generation sequencing (mNGS) was 87.5% (7/8). On multivariable analysis, the extrahepatic organ involved (p = 0.029) and hepatomegaly (p = 0.025) were two independent factors associated with poor outcomes.ConclusionsPLA is usually seen in children with predisposing factors. Malignant hematology and primary immunodeficiency disease were the most common underlying diseases. Extrahepatic organ involvement and hepatomegaly are associated with poor prognosis. Increased use of mNGS could be beneficial for identifying pathogens.

Iron regulatory protein 2 contributes to antimicrobial immunity by preserving lysosomal function in macrophages

Colorectal cancer and Crohn's disease patients develop pyogenic liver abscesses due to failures of immune cells to fight off bacterial infections. Here, we show that mice lacking iron regulatory protein 2 (Irp2), globally (Irp2-/-) or myeloid cell lineage (Lysozyme 2 promoter-driven, LysM)-specifically (Irp2ΔLysM), are highly susceptible to liver abscesses when the intestinal tissue was injured with dextran sodium sulfate treatment. Further studies demonstrated that Irp2 is required for lysosomal acidification and biogenesis, both of which are crucial for bacterial clearance. In Irp2-deficient liver tissue or macrophages, the nuclear location of transcription factor EB (Tfeb) was remarkably reduced, leading to the downregulation of Tfeb target genes that encode critical components for lysosomal biogenesis. Tfeb mislocalization was reversed by hypoxia-inducible factor 2 inhibitor PT2385 and, independently, through inhibition of lactic acid production. These experimental findings were confirmed clinically in patients with Crohn's disease and through bioinformatic searches in databases from Crohn's disease or ulcerative colitis biopsies showing loss of IRP2 and transcription factor EB (TFEB)-dependent lysosomal gene expression. Overall, our study highlights a mechanism whereby Irp2 supports nuclear translocation of Tfeb and lysosomal function, preserving macrophage antimicrobial activity and protecting the liver against invading bacteria during intestinal inflammation.