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Journal of Visceral Surgery Sep 2015Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity.... (Review)
Review
Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity. Infection is usually bacterial, sometimes parasitic, or very rarely fungal. In the Western world, bacterial (pyogenic) HA is most prevalent; the mortality is high approaching 15%, due mostly to patient debilitation and persistence of the underlying cause. In South-East Asia and Africa, amebic infection is the most frequent cause. The etiologies of HA are multiple including lithiasic biliary disease (cholecystitis, cholangitis), intra-abdominal collections (appendicitis, sigmoid diverticulitis, Crohn's disease), and bile duct ischemia secondary to pancreatoduodenectomy, liver transplantation, interventional techniques (radio-frequency ablation, intra-arterial chemo-embolization), and/or liver trauma. More rarely, HA occurs in the wake of septicemia either on healthy or preexisting liver diseases (biliary cysts, hydatid cyst, cystic or necrotic metastases). The incidence of HA secondary to Klebsiella pneumoniae is increasing and can give rise to other distant septic metastases. The diagnosis of HA depends mainly on imaging (sonography and/or CT scan), with confirmation by needle aspiration for bacteriology studies. The therapeutic strategy consists of bactericidal antibiotics, adapted to the germs, sometimes in combination with percutaneous or surgical drainage, and control of the primary source. The presence of bile in the aspirate or drainage fluid attests to communication with the biliary tree and calls for biliary MRI looking for obstruction. When faced with HA, the attending physician should seek advice from a multi-specialty team including an interventional radiologist, a hepatobiliary surgeon and an infectious disease specialist. This should help to determine the origin and mechanisms responsible for the abscess, and to then propose the best appropriate treatment. The presence of chronic enteric biliary contamination (i.e., sphincterotomy, bilio-enterostomy) should be determined before performing radio-frequency ablation and/or chemo-embolization; substantial stenosis of the celiac trunk should be detected before performing pancreatoduodenectomy to help avoid iatrogenic HA.
Topics: Anti-Bacterial Agents; Catheter Ablation; Chemoembolization, Therapeutic; Combined Modality Therapy; Drainage; Humans; Liver Abscess
PubMed: 25770745
DOI: 10.1016/j.jviscsurg.2015.01.013 -
British Medical Bulletin Dec 2019Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The... (Review)
Review
INTRODUCTION
Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings.
SOURCES OF DATA
We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'.
AREAS OF AGREEMENT
Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics.
AREAS OF CONTROVERSY
In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings.
GROWING POINTS
As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced.
AREAS TIMELY FOR DEVELOPING RESEARCH
The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.
Topics: Anti-Bacterial Agents; Humans; Liver Abscess; Liver Abscess, Amebic; Liver Abscess, Pyogenic; Medically Underserved Area; Prognosis
PubMed: 31836890
DOI: 10.1093/bmb/ldz032 -
Revue Medicale de Liege Nov 2020Liver abscess is a rare condition. There are multiple etiologies and mortality linked to the infections or local complications is high. The rapid diagnosis and the... (Review)
Review
Liver abscess is a rare condition. There are multiple etiologies and mortality linked to the infections or local complications is high. The rapid diagnosis and the implementation of an adequate and effective treatment are essential to allow healing without sequels. We report the case of a monofocal bacterial hepatic abscess in a 61-year-old patient with an iatrogenic origin. A review of the literature is proposed in order to address the incidence, the different microorganisms, the different etiologies and the different possibilities of treatment. It should be noted that mycotic abscess, which is extremely rare outside the immunocompromised patient, will not be discussed in this article.
Topics: Humans; Liver Abscess; Middle Aged
PubMed: 33155447
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Jun 2023Liver abscess caused by foreign bodies constitutes a rare medical problem that few of us will encounter in a clinical setting.
BACKGROUND
Liver abscess caused by foreign bodies constitutes a rare medical problem that few of us will encounter in a clinical setting.
CASE PRESENTATION
We describe a case where a woman presented with sepsis and abdominal pain. Computed tomography (CT) of her abdomen revealed a large hepatic abscess containing a foreign body. Based on the size, shape and density of the object, a fishbone was suspected.
INTERPRETATION
We hypothesise that she swallowed a fishbone, which then perforated the gastrointestinal tract and lodged in the liver. After interdisciplinary discussion it was decided to proceed with conservative management, and the patient was treated successfully with antibiotics for a total of 31 days.
Topics: Animals; Female; Humans; Abdominal Pain; Foreign Bodies; Liver Abscess; Tomography, X-Ray Computed
PubMed: 37376945
DOI: 10.4045/tidsskr.23.0012 -
Journal of Animal Science Nov 2022Liver abscess etiology in feedlot steers involves the escape of bacteria from the digestive tract to form a polymicrobial abscess within or on the external surface of...
Liver abscess etiology in feedlot steers involves the escape of bacteria from the digestive tract to form a polymicrobial abscess within or on the external surface of the liver. However, little is known about the effects of feedlot finishing systems on the microbial composition of the liver abscess purulent material. Liver abscesses were collected at the time of harvest from steers originating from a single feedlot managed in either a traditional program (which included tylosin phosphate supplementation) or a natural program (without tylosin phosphate supplementation). The purulent material of liver abscesses from traditionally managed steers (N = 53 abscesses) and that of naturally managed steers (N = 62 abscesses) was characterized using the V4 region of the 16S rRNA gene. Two phyla and three genera were found in greater than 1% relative abundance across all abscesses. The genus Fusobacterium was identified in all liver abscess samples and accounted for 64% of sequencing reads. Bacteroides and Porphyromonas genera accounted for 33% and 1% of reads, respectively. Trueperella was more likely to be found in the liver abscesses of naturally managed steers than traditionally managed steers (P = 0.022). Over 99% of the genus-level bacterial sequences observed across all liver abscesses belonged to Gram-negative genera. Bacteria known to colonize both the rumen and hindgut were identified within liver abscesses. No differences in alpha diversity or beta diversity were detected between liver abscess communities (between the two management programs or individual pens) when tested as richness, Shannon Diversity Index, or weighted UniFrac distances (P > 0.05). These results were consistent with previous identification of Fusobacterium necrophorum as the primary bacteriologic agent within liver abscesses and emphasized the relationship between the gastrointestinal microbiota and liver abscess formation. Though the microbiota of the liver abscess purulent material was similar between steers fed an antibiotic-free diet and those fed an antibiotic-containing diet from the same feedlot, divergence was detected in liver abscess communities with some being dominated by Fusobacterium and others being dominated by Bacteroides.
Topics: Cattle; Animals; Tylosin; RNA, Ribosomal, 16S; Animal Feed; Cattle Diseases; Liver Abscess; Microbiota; Anti-Bacterial Agents; Bacteria; Phosphates
PubMed: 35938914
DOI: 10.1093/jas/skac252 -
British Medical Journal May 1980
Topics: Fever; Humans; Jaundice; Liver Abscess; Middle Aged; Prognosis
PubMed: 7388441
DOI: No ID Found -
Revista Da Sociedade Brasileira de... 2022
Topics: Appendicitis; Humans; Length of Stay; Liver Abscess, Pyogenic; Surgical Wound Infection
PubMed: 36197379
DOI: 10.1590/0037-8682-0244-2022 -
Disease Markers 2022Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic...
BACKGROUND
Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic patients with BLA have higher rates of related adverse events than patients without diabetes.
AIM
To explore the clinical characteristics of BLA complicated with diabetes and nondiabetes-related BLA.
METHODS
From January 2019 to June 2020, 61 diabetic patients with BLA were included as the study group, and 61 BLA patients without diabetes were included as the control group. Clinical manifestations, laboratory examination index (prothrombin activity (PTA), albumin (propagated), white blood cell count (WBC), red blood cell count (RBC), plasma fibrinogen (FIB), C-reactive protein (CRP), neutrophil percentage (NEUT), and prealbumin (PA)) levels, blood cultivation, and fester situation in the two groups were analyzed.
RESULTS
No differences of Fever, right upper abdominal pain, jaundice, vomiting and nausea, liver tenderness, and liver pain upon percussion were observed between the study and control groups. However, chill, cough and expectoration, and liver pain upon percussion were higher in the study group, while abdominal distension was lower. WBC, RBC, PA, PTA, FIB, and CRP were higher than the control group. NEUT was higher in the study group than in the control group and Alb was lower than that in the control group. There was no significant difference between the positivity of blood bacterial culture in the study and control groups. The positivity rate of in Gram-negative aerobic bacteria in the study group was higher than that in the control group. There was no significant difference between the positivity of fester culture of the two groups. The positivity of in Gram-negative aerobic bacteria in the study group was higher than that in the control group. The positivity of was lower in the study group than in the control group.
CONCLUSION
Clinical manifestations and laboratory results of BLA patients with and without diabetes mellitus were significantly different. The symptoms of diabetics with BLA were serious.
Topics: Bacteria; C-Reactive Protein; Diabetes Mellitus; Escherichia coli; Humans; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Pain
PubMed: 35521637
DOI: 10.1155/2022/7512736 -
Annals of African Medicine 2022This study aimed to evaluate the safety and efficacy of USG-guided percutaneous drainage in liver abscesses of >5 cm. A lot of literature is available on the minimally...
BACKGROUND
This study aimed to evaluate the safety and efficacy of USG-guided percutaneous drainage in liver abscesses of >5 cm. A lot of literature is available on the minimally invasive treatment of liver abscesses since its introduction in the early 1980s. This study focuses on the eastern Indian population and the outcome of treatment of liver abscess of >5 cm by means of catheter drainage and the use of antibiotics.
PATIENTS AND METHODS
This is a retrospective study conducted on a total of fifty patients over a period of 1 year, 1 month (from June 2017 to June 2018). Only patients with liver abscess with size >5 cm were included in the study. The demographic characteristics; comorbidities; and clinical, radiological, and bacteriological characteristics of liver abscesses in the eastern Indian population and the safety and efficacy of catheter drainage were evaluated.
RESULTS
It was found that because of preprocedural empirical antibiotic intake, 70% of the patients had no growth in the pus, whereas 12% had Entamoeba histolytica, 8% had Escherichia coli, and 6% had Klebsiella pneumoniae as the causative agent. The total duration of hospital stay ranged from 3 to 22 days, and the duration of intravenous antibiotics ranged from 1 to 9 days with a clinical success rate of 96% without any drainage-related complications.
CONCLUSION
In contradiction to the earlier belief, percutaneous drainage is a safe and effective means of treatment in liver abscesses of >5 cm with high clinical success rate and reduced duration of intravenous antibiotic requirement as well as hospital stay.
Topics: Anti-Bacterial Agents; Catheters; Drainage; Escherichia coli; Humans; Liver Abscess; Retrospective Studies; Treatment Outcome
PubMed: 35313400
DOI: 10.4103/aam.aam_68_20 -
Le Infezioni in Medicina Sep 2018Citrobacter koseri is a rare cause of liver abscess with two reported cases in diabetic patients. We report a rare case of C. koseri liver abscess with C. koseri...
Citrobacter koseri is a rare cause of liver abscess with two reported cases in diabetic patients. We report a rare case of C. koseri liver abscess with C. koseri bacteremia in an elderly male with chronic kidney disease. He presented vomiting and weakness without any other signs. He was diagnosed with liver abscess by ultrasound, and blood culture showed C. koseri growth. The patient was treated effectively with a course of antibiotics and drainage. When C. koseri is isolated in patients with comorbidity, such as chronic kidney disease, we should consider the possibility of abscess including liver abscess and utilize a combined treatment of drainage and course of antibiotics for mixed infection.
Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Breast Neoplasms, Male; Ciprofloxacin; Citrobacter koseri; Combined Modality Therapy; Drainage; Enterobacteriaceae Infections; Humans; Liver Abscess; Male; Pancreatitis; Papilloma, Intraductal; Renal Insufficiency, Chronic
PubMed: 30246771
DOI: No ID Found