Pyogenic Liver Abscess Research Articles

A Case Report of Disseminated Nocardiosis in a Patient with HIV Infection: Concurrent Liver, Pulmonary, and Brain Involvements

Introduction: Disseminated nocardiosis is a rare but life-threatening infectious disease that occurs most often in immunocompromised individuals. This report presents a human immunodeficiency virus (HIV)-infected patient with disseminated nocardiosis in the liver, lung, and brain. Case Presentation: A 38-year-old woman who had recently been diagnosed with HIV infection complained of fever, abdominal pain, productive coughs, and occasional headaches from 2 months ago. Imaging findings of her abdomen and lungs displayed evidence of pyogenic liver abscess and lobar pneumonia with abscess formation, respectively. The patient underwent percutaneous liver abscess drainage and bronchoalveolar lavage (BAL). Using reverse transcription-polymerase chain reaction (RT-PCR), the genome of Nocardia farcinica was detected in the specimens obtained from both procedures. Besides, she had seizures during hospitalization. Based on cerebrospinal fluid (CSF) analysis, the specimen was positive for N. farcinica. Brain imaging also revealed evidence of multiple bacterial abscess formation. She was diagnosed with disseminated nocardiosis and treated with intravenous imipenem, trimethoprim/sulfamethoxazole, and amikacin, followed by appropriate oral agents. After a 6-month follow-up, the patient had no symptoms. Additionally, the lesions improved on brain imaging. Conclusions: Patients who are HIV-positive are particularly prone to opportunistic infections. Health care providers should consider all pathogens, even rare ones, like Nocardia spp., to establish a diagnosis if they're present. Furthermore, in cases initially diagnosed with localized nocardiosis, other body organs should also be reviewed so that the disseminated form of the disease can be diagnosed and treated immediately.

Hypervirulent Capsular Serotypes K1 and K2 Klebsiella pneumoniae Strains Demonstrate Resistance to Serum Bactericidal Activity and Galleria mellonella Lethality.

Hypervirulent Klebsiella pneumoniae (hvKp) is a variant that has been increasingly linked to severe, life-threatening infections including pyogenic liver abscess and bloodstream infections. HvKps belonging to the capsular serotypes K1 and K2 have been reported worldwide, however, very scarce studies are available on their genomics and virulence. In the current study, we report four hypermucoviscous extended-spectrum β-lactamase-producing hvKp clinical strains of capsular serotype K1 and K2 isolated from pus and urine of critically ill patients in tertiary care hospitals in Oman. These strains belong to diverse sequence types (STs), namely ST-23(K1), ST-231(K2), ST-881(K2), and ST-14(K2). To study their virulence, a Galleria mellonella model and resistance to human serum killing were used. The G. mellonella model revealed that the K1/ST-23 isolate was the most virulent, as 50% of the larvae died in the first day, followed by isolate K2/ST-231 and K2/ST-14, for which 75% and 50% of the larvae died in the second day, respectively. Resistance to human serum killing showed there was complete inhibition of bacterial growth of all four isolates by the end of the first hour and up to the third hour. Whole genome sequencing (WGS) revealed that hvKp strains display a unique genetic arrangement of k-loci. Whole-genome single-nucleotide polymorphism-based phylogenetic analysis revealed that these hvKp isolates were phylogenetically distinct, belonging to diverse clades, and belonged to different STs in comparison to global isolates. For ST-23(K1), ST-231(K2), ST-881(K2), and ST-14(K2), there was a gradual decrease in the number of colonies up to the second to third hour, which indicates neutralization of bacterial cells by the serum components. However, this was followed by a sudden increase of bacterial growth, indicating possible resistance of bacteria against human serum bactericidal activity. This is the first report from Oman detailing the WGS of hvKp clinical isolates and assessing their resistance and virulence genomics, which reinforce our understanding of their epidemiology and dissemination in clinical settings.

Efficacy of Tounongsan decoction on pyogenic liver abscess: network pharmacology and clinical trial validation.

To elucidate the molecular mechanisms governing the effect of Tounongsan decoction (, TNS) on the pyogenic liver abscess. Based on oral bioavailability and drug-likeness, the main active components of TNS were screened using the Traditional Chinese Medicine Systems Pharmacology platform. The GeneCard and UniProt databases were used to establish a database of pyogenic liver abscess targets. The interactive network map of drug-ingredients-target-disease was constructed using Cytoscape software (Version 3.7.2). A protein-protein interaction network was constructed using the STRING database, and the related protein interaction relationships were analyzed. biological process of gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed for the core targets. Finally, a clinical trial was performed to verify the reliability of the network pharmacology. Forty active components of TNS decoction were obtained, and 61 potential targets and 11 proteins were identified. Pathways involved in the treatment of pyogenic liver abscess include the phosphatidylinositide 3-kinases-protein kinase B (PI3K-AKT), advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE), and tumor necrosis factor (TNF) signaling pathways. The results of network pharmacology analysis combined with clinical trials validated that TNS decoction could alleviate the inflammatory response of pyogenic liver abscesses by decreasing interleukin 6 (IL-6) levels. TNS decoction has the characteristics of being multi-system, multi-component, and multi-target. Active ingredients in TNS, such as quercetin, kaempferol, fisetin, and β-sitosterol, have strong potential to be candidate drugs for treating pyogenic liver abscesses. The possible mechanism of TSN decoction includes regulating immune and inflammatory responses and reducing IL-6 production to control inflammatory development.

Comparative Incidence of Pyogenic and Amoebic Liver Abscesses in Trauma and Emergency Patients at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna: A One-Year Observational Study.

Liver abscesses, particularly pyogenic and amoebic types, pose a significant healthcare challenge, especially in developing countries. Accurate differentiation and effective treatment of these abscess types are crucial in emergency medical settings. This study aims to analyze the incidence, clinical characteristics, and treatment outcomes of pyogenic and amoebic liver abscesses in a trauma and emergency department setting. Conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, this one-year observational study involved 100 patients diagnosed with liver abscesses. The study employed a comprehensive approach, examining incidence rates, demographic trends, clinical presentations, treatment modalities, and outcomes, including recurrence rates. The study observed a higher incidence of pyogenic liver abscesses, accounting for 60% of cases (n=60), compared to amoebic liver abscesses, which constituted 40% (n=40). In terms of demographics, pyogenic liver abscesses were more prevalent among older males, with the average age being 48 years, and 70% (n=42) of the patients were male. In contrast, amoebic liver abscess patients had an average age of 42 years, with 60% (n=24) being male. Key clinical findings revealed that pyogenic liver abscess cases (n=60) had higher white blood cell counts and elevated liver enzyme levels than those with amoebic liver abscesses (n=40). The treatment outcomes indicated high success rates for both types of liver abscesses. Pyogenic liver abscesses had a success rate of 90% (n=54), while amoebic liver abscesses showed a slightly higher success rate at 95% (n=38). However, there was a notable difference in recurrence rates: pyogenic liver abscesses had a recurrence rate of 8.3% (n=5), whereas amoebic liver abscesses had a lower recurrence rate of 2.5% (n=1). The logistic regression analysis conducted to identify potential predictors of treatment success did not reveal any statistically significant factors across both types of liver abscesses. The study highlights a higher incidence of pyogenic liver abscesses in an urban Indian healthcare setting and the complexity of predicting treatment outcomes based on demographic and clinical factors. The findings emphasize the need for nuanced clinical approaches and vigilant post-treatment monitoring, especially for pyogenic liver abscesses. They also underscore the importance of further research to explore additional variables influencing liver abscess treatment outcomes.

Molecular mechanism of Xuebijing in treating pyogenic liver abscess complicated with sepsis.

Xuebijing (XBJ) can alleviate the inflammatory response, improve organ function, and shorten the intensive care unit (ICU) stay in patients with pyogenic liver abscess (PLA) complicated with sepsis, but the molecular mechanisms have not been elucidated. This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach. The active ingredients and targets of XBJ were retrieved from the ETCM database. Potential targets related to PLA and sepsis were retrieved from the GeneCards, PharmGKB, DisGeNet, Online Mendelian Inheritance in Man (OMIM), Therapeutic Targets Database (TTD), and DrugBank databases. The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets. Protein-protein interaction networks were analyzed using the STRING database. Potential treatment targets were imported into the Metascape platform for Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Molecular docking was performed to validate the interactions between active ingredients and core targets. XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis. Interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor (TNF) were identified as core targets. KEGG enrichment analysis revealed important pathways, including the interleukin-17 (IL-17) signaling pathway, the TNF signaling pathway, the nuclear factor-kappa B (NF-κB) signaling pathway, and the Toll-like receptor (TLR) signaling pathway. Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets. XBJ may exert therapeutic effects on PLA complicated with sepsis by modulating signaling pathways, such as the IL-17, TNF, NF-κB, and TLR pathways, and targeting IL-1β, IL-6, and TNF.

Higher Virulence Renders K2 Klebsiella pneumoniae a Stable Share Among Those from Pyogenic Liver Abscess.

To explore why serotype K2 accounts for a stable share in Klebsiella pneumoniae from pyogenic liver abscess (PLA). Totally 15 K2 K. pneumoniae strains from PLA, 21 K2 from non-PLA, and 31 K1 from PLA were collected from China. Sequence typing, molecular serotyping, regular PCR, and Galleria mellonella lethality were performed. A total of 12 virulence genes were detected: peg-344, allS, p-rmpA, p-rmpA2, c-rmpA, fimH, mrkD, iucA, iroN, irp2, entB, and wzi. The differences between K2 K. pneumoniae strains from PLA and non-PLA were investigated along with K1 ones. Significant differences were found between K2 strains from PLA and non-PLA for the rates of virulence genes peg-344 and iucA. The latter group also showed more diverse sequence types than the former. Significant differences were only found for virulence genes allS and irp2 between K1 and K2 strains from PLA. Based on the equal virulence factors backgrounds other than serotypes, K2 strain is more virulent than K1 as G. mellonella lethality confirmed. Gene p-rmpA only brings equal virulence to p-rmpA plus p-rmpA2 in K2 strain. Based on the same virulence factors backgrounds except serotypes, K2 K. pneumoniae is more virulent than K1 from PLA, which provides a survival advantage to maintain a stable share.

Pyogenic Liver Abscess. Pet-Ct as a New Diagnostic Resource and Suction Drainage as an Effective Therapeutic Method

Pyogenic Liver Abscess. Pet-Ct as a New Diagnostic Resource and Suction Drainage as an Effective Therapeutic Method

Pyogenic Liver abscess and Gastrointestinal Variant of Lemierre Syndrome in Patient with Crohn’s Disease

Pyogenic Liver abscess and Gastrointestinal Variant of Lemierre Syndrome in Patient with Crohn’s Disease

Profile of Amoebic vs. Pyogenic Liver Abscess and Comparison of Demographical, Clinical, Radiological, and Laboratory Profiles of These Patients from Three Secondary Care Centers in Senegal

Profile of Amoebic vs. Pyogenic Liver Abscess and Comparison of Demographical, Clinical, Radiological, and Laboratory Profiles of These Patients from Three Secondary Care Centers in Senegal

Characteristics of Klebsiella pneumoniae pyogenic liver abscess from 2010–2021 in a tertiary teaching hospital of South China

Pyogenic liver abscess (PLA) is a severe and potentially fatal infectious disease. Klebsiella pneumoniae (K. pneumoniae) is the predominant pathogen responsible for PLA. This study aims to investigate the clinical characteristics and prognostic factors of K. pneumoniae-induced pyogenic liver abscess (KP-PLA), particularly those caused by carbapenem-resistant K. pneumoniae (CRKP). Analyses were performed on PLA patients from January 2010 to December 2021, to investigate the differences of K. pneumoniae from other etiologically infected PLA patients. Univariate and multivariate logistic regression analyses were used to compare prognostic factors between patients with carbapenem-resistant K. pneumoniae PLA (CRKP-PLA) and patients with carbapenem-sensitive K. pneumoniae PLA. Univariate analysis demonstrated a significant association between KP-PLA and factors including diabetes mellitus (P < 0.001), cholecystitis and cholelithiasis (P = 0.032), single abscess (P = 0.016), and abscesses with a diameter over 50 mm (P = 0.004). The CRKP group exhibited a higher prevalence of therapeutic interventions before K. pneumoniae infection, including abdominal surgery, mechanical ventilation, sputum suction, tracheal cannula, routine drainage of the abdominal cavity, and peripherally inserted central venous catheters (P < 0.05). Multivariate logistic regression analysis revealed that admission to the intensive care unit was an independent risk factor associated with CRKP-PLA (odds ratio 36; 95% confidence interval 1.77-731.56; P = 0.020). The KP-PLA patients were significantly associated with diabetes and were more likely to have single abscesses larger than 50 mm. PLA patients with a history of admission to intensive care unit or invasive therapeutic procedures should be given special consideration if combined with CRKP infection.

Current Management of Liver Abscess: A Narrative Review

Liver abscess can be divided into pyogenic and amoebic liver abscess. The common organisms that cause pyogenic liver abscess include Escherichia Coli, with amoebic liver abscess being caused by Entamoeba histolytica. The diagnosis is made by ultrasound, computerized tomography, and magnetic resonance imaging of the liver. The treatment can be divided into medical therapy which involves percutaneous drainage and intravenous antibiotics, and surgical therapy which includes surgical drainage either by open or laparoscopic surgery. Surgical drainage is indicated for patients who have failed medical therapy. We have conducted this review article to look at the current management of liver abscess with regards to the role of percutaneous drainage and surgical drainage.

Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess

Colorectal cancer (CRC) can compromise the mucosal barrier and subsequently allow a route for bacterial invasion into the portal system or systemic circulation. Despite preliminary data suggesting that patients who experienced pyogenic liver abscess (PLA) have higher CRC incidence rates, data from outside the Southeast Asian population are sparse. To investigate whether there is an association between PLA and the subsequent incidence of diagnosed CRC using the Veterans Health Administration (VHA) cohort. A patient-level matched retrospective cohort study was conducted at 127 VHA hospitals across the US from January 1, 2003, to December 31, 2020. Patients were followed up to 10 years from PLA diagnosis. Data analysis was performed from April 14, 2002, to October 31, 2023. All patients who were admitted to VHA hospitals with a diagnosis of PLA were included. For each patient with PLA, up to 3 controls without diagnosis of PLA, matching age, sex, and health care facility, were selected. Pyogenic liver abscess. The primary outcome was CRC diagnosis during the follow-up period. A multivariable Fine-Gray subdistribution regression model with time-dependent coefficient was used to estimate the time-varying hazard ratio (HR) of CRC incidence while accounting for mortality as a competing event. A total of 8286 patients with PLA (male, 96.5%; mean [SD] age, 65.8 [11.9] years) and 23 201 patient-level matched controls (male, 96.3%; mean age, 65.3 [11.7] years) were included. A diagnosis of CRC was found in a significantly higher proportion of patients with PLA compared with controls (1.9% [159 of 8286] vs 0.8% [196 of 23 201]; P < .001). The incidence of CRC was significantly higher among patients with PLA during the first 3 years from PLA diagnosis (HR, 3.64; 95% CI, 2.70-4.91 at 0.5 years; HR, 2.51; 95% CI, 1.93-3.26 at 1 year; HR, 1.74; 95% CI, 1.33-2.28 at 2 years; and HR, 1.41; 95% CI, 1.05-1.89 at 3 years), but not significant after 3 years. This association was not observed among patients whose PLA was likely secondary to cholangitis or cholecystitis (HR, 1.78; 95% CI, 0.89-3.56 at 0.5 years). In this patient-level matched retrospective cohort study, a significantly higher incidence of CRC was observed up to 3 years from PLA diagnosis. The findings suggest that offering CRC screening for patients with cryptogenic PLA may be useful, especially patients who have not been screened according to guidelines.

Real-time loop-mediated isothermal amplification (real-time LAMP) assay for rapid diagnosis of amoebic liver abscess.

Among the parasitic diseases, amoebic liver abscess (ALA) ranks second to malaria in terms of mortality. Due to the poor sensitivity of conventional diagnostic methods, there is a need for the development of effective and rapid diagnostic methods for ALA. Thus, the purpose of this work was to develop a real-time loop-mediated isothermal amplification (RT-LAMP) assay specific to Entamoeba histolytica. Further, we compared the performance of real-time LAMP with conventional and real-time PCR (RT-PCR) targeting 18S small subunit ribosomal RNA (18S SSU rRNA) gene of E. histolytica in patients with ALA. A total of 126 liver samples were obtained for the study. Of these, 96 aspirated pus samples were obtained from patients suffering from an ALA (serology confirmed, anti-amoebic immunoglobulin IgG positive), 19 aspirated pus samples from patients with pyogenic liver abscess (PLA, 16S RNA gene positive) and 11 autopsy liver tissues. The results showed that the DNA of E. histolytica was detected in 81 samples by conventional PCR, 93 by RT-PCR and 95 by RT-LAMP. The analytical sensitivity of the RT-LAMP assay was much higher than the other two techniques. RT-LAMP assay was able to amplify up to one copy of the targeted gene of E. histolytica while conventional PCR and RT-PCR could amplify up to 103 and 102 copies of the targeted gene of E. histolytica, respectively. In conclusion, RT-LAMP proved to be a sensitive, specific and rapid test which can be utilised as an effective tool for the diagnosis of ALA.

Hypervirulent Klebsiella pneumoniae: An update on epidemiology, detection and antibiotic resistance.

Klebsiella pneumoniae is a major human pathogen as it is responsible for various infections. In the past years hypervirulent K. pneumoniae (hvKP) emerged and disseminated worldwide. In this review a summary will be given about epidemiology, detection and antibiotic resistance of hypervirulent K.pneumoniae. A common feature of hypervirulent K. pneumoniae is a combined expression of several virulence factors. A mucoviscosus phenotype, certain capsulare serotypes (e.g.: K1, K2, K28, K47, K63) together with additional genetic markers namely, magA, rmpA or iucABCD, are needed in combinations to achieve the hypervirulent pathotype. Plasmid coded virulence determinants are also detected, that indicates horizontal gene transfer of hypervirulence factors in K. pneumoniae.Interestingly, infections caused by hypervirulent K. pneumoniae occur usually in the community in otherwise healthy people, and during these infections multiple infection sites are detected. Clinical pictures include both invasive infections and local abscess formation. Pyogenic liver abscess is the most frequently reported clinical manifestation and abscess formation in brain, spleen and lung are also diagnosed. Additionally, meningitis, endophthalmitis, trombophlebitis, pneumonia can also develop.In the early reports, hypervirulent K. pneumoniae strains exhibited enhanced virulence but these were susceptible to commonly used antibiotics. However, recently KPC, VIM, NDM and OXA-48 carbapenemase producing hypervirulent K. pneumoniae strains are increasingly reported, furthermore, well-known high-risk K. pneumoniae clones (e.g.: ST11, ST147, ST307) can develop hypervirulent pathotype, that poses an even more alarming challenge.

Characteristics and Management of Pyogenic Liver Abscess: A Rural Senegalese Experience

Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context.&#x0D; Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal.&#x0D; Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%.&#x0D; Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.

206. Prevalence of liver abscess in patients with Klebsiella pneumoniae bacteremia during a 5-year experience in a tertiary hospital in Thailand

Abstract Background The incidence of liver abscess in Thailand has increased in number nowadays. K. pneumoniae is the most common cause of pyogenic liver abscess in the recent large series. Liver abscess can be a complication of K. pneumoniae bacteremic patients. We aimed to study the prevalence of liver abscess in patients with K. pneumoniae bacteremia and the comparison in clinical and laboratory characteristics of patients with K. pneumoniae between a group with liver abscess and the other without liver abscess. Methods This is a retrospective study; data were collected in Bhumibol Adulyadej Hospital among patients who were diagnosed with K. pneumoniae bacteremia between January 2014 – December 2019 and compared the difference in clinical and laboratory characteristics of patients between a group with liver abscess and the other without liver abscess. Results Of All 758 patients with K. pneumoniae bacteremia, 335 (44.19%) patients were done abdominal imaging, and 37 (4.9%) patients were found with liver abscess. The mean age was 65 years old, and most were male. Comorbidities were present in almost half of the patients including diabetes (118 patients, 35.22%), previous hepatobiliary surgery (21, 6.26%), and history of cancer (70, 20.90%). The other demographic data are shown in Table 1. Patients with liver abscess had diabetes (54.1% vs 29.3%, p-value = 0.082) and fever (91.89% vs 76.84%, p-value = 0.056) more than patients without abscess, however only 29.7% of patients with liver abscess had abdominal pain. Elevated transaminases above 2 times the upper limit of normal range are more frequent among patients with liver abscess than patients without abscess, for AST; 54.1%vs 35.30% (p-value = 0.026) and ALT; 40.5% vs 25.20% (p-value = 0.048). Clinical and laboratory characteristics are shown in Table 2.Table 1:Demographic data of patients with K. pneumoniae bacteremiaTable 2:Clinical and laboratory characteristics of patients with K. pneumoniae bacteremia Conclusion The prevalence of liver abscess in patients with K. pneumoniae bacteremia is 37 from 758 (4.9%). Liver abscess should be suspected in K. pneumoniae bacteremic patients who have elevated transaminases above 2 times the upper limit of normal range regardless of abdominal pain. Disclosures All Authors: No reported disclosures

Phenotypic and genetic characterization of hypervirulent Klebsiella pneumoniae in patients with liver abscess and ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) and pyogenic liver abscess (PLA) due to Klebsiella pneumoniae infection can trigger life-threatening malignant consequences, however, there are few studies on the strain-associated clinical pathogenic mechanisms between VAP and PLA. A total of 266 patients consist of 129 VAP and 137 PLA were included for analysis in this study. We conducted a comprehensive survey for the two groups of K. pneumoniae isolates, including phenotypic experiments, clinical epidemiology, genomic analysis, and instrumental analysis, i.e., to obtain the genomic differential profile of K. pneumoniae strains responsible for two distinct infection outcomes. We found that PLA group had a propensity for specific underlying diseases, especially diabetes and cholelithiasis. The resistance level of VAP was significantly higher than that of PLA (78.57% vs. 36%, P < 0.001), while the virulence results were opposite. There were also some differences in key signaling pathways of biochemical processes between the two groups. The combination of iucA, rmpA, hypermucoviscous phenotype, and ST23 presented in K. pneumoniae infection is more important and highly prudent for timely treatment. The present study may contribute a benchmark for the K. pneumoniae clinical screening, epidemiological surveillance, and effective therapeutic strategies.

Literature- and Experience-Based Consensus for Acute Post-operative Endophthalmitis and Endogenous Endophthalmitis in Taiwan.

Clinical practices on acute post-operative and endogenous endophthalmitis (EnE) are highly variable among clinicians due to a lack of up-to-date, high-quality evidential support. An expert consensus is thus much needed. A panel consisting of ten retinal specialists in Taiwan was organized. They evaluated relevant literature and developed key questions regarding acute post-operative and EnE that are cardinal for practice but yet to have conclusive evidence. The panel then attempted to reach consensus on all the key questions accordingly. There were eight key questions proposed and their respective consensus statements were summarized as follows: Gram staining and culture are still the standard procedures for the diagnosis of endophthalmitis. Vitrectomy is recommended to be performed earlier than the timing proposed by the Endophthalmitis Vitrectomy Study (EVS). Routine intracameral antibiotic injection for post-cataract surgery endophthalmitis prophylaxis is not recommended because of potential compounding error hazards and a lack of support from high-quality studies. Routine fundus examination is recommended for all patients with pyogenic liver abscess. In EnE, vitrectomy is recommended if diffused and dense vitritis is present, or if the disease progresses. These consensus statements may work as handy guidance or reference for clinical practices of acute post-operative and EnE.

Pyogenic liver abscess as an extra-intestinal manifestation of pediatric Crohn’s disease

Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) characterized by chronic granulomatous inflammation of any part of the body, primarily the gastrointestinal (GI) tract, and is increasing in incidence worldwide. As CD is a systemic disease, the features of CD typically manifest in the GI tract; however, a variety of extra-intestinal manifestations, such as the involvement of joints, skin, and eyes may also occur. Although pyogenic liver abscess itself is rare in the general population (approximately 3–5 per 100,000 hospital admissions), it is also an unusual and rare presentation in pediatric CD patients. In this report, we present a case of pyogenic liver abscess in a 7-year-old female CD patient and discuss the clinical features, laboratory findings, imaging studies, and pathologic report of liver biopsy.

Surgical treatment of hepatic abscess guided by intraoperative ultrasound

Pyogenic liver abscesses are one of the complications of acute cholecystitis. Its dissemination can occur hematogenous, through the hepatic artery or the portal vein, or through biliary dissemination, due to ascending cholangitis. The germs involved are Escherichia Coli, Klebsiela pneumoniae, Anaerobic Streptococci and Enterococci. The importance of a prompt diagnosis and treatment is based on the severity of the clinical picture and its complications, such as morbidity and mortality. The main risk factors are Diabetes, Hypertension, cholelithiasis and previous abdominal surgery. The purpose of this study is the evaluation of the case and discussion about the forms of treatment and the demonstration of the importance of using the Ultrasound for localization of deep intrahepatic collections.