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Intra-Abdominal Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The mainstay of treatment is drainage. A common empirical antibiotic treatment regimen is ceftriaxone + metronidazole. Classically, a liver abscess is treated for 4–6 weeks but is not based on strong evidence. It may be reasonable to repeat imaging after 3 weeks of drainage and antibiotic treatment and decide further management on a case-by-case basis. Differential diagnosis of a pyogenic liver abscess is Candida liver abscess, amoebic liver abscess and echinococcal abscess. Hepatosplenic candidiasis with multiple small abscesses is a rare phenomenon and occurs in patients with haematologic malignancies during recovery of neutrophil counts following a neutropaenic episode. Surgical drainage may be indicated if there is an inadequate response to percutaneous drainage. Abscesses smaller than 5 cm may be too small to be drained. Discuss with the radiologist if instead a needle aspiration can be performed.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Pyogenic liver abscess is a life-threatening, potentially curable disease, which frequently is manifest as unexplained fever or FUO.66-68 The pyogenic microorganisms reach the liver via the biliary tract (usually), portal system, hepatic artery or through direct extension from a neighboring organ. Pyogenic abscesses may complicate hepatic metastases undergoing necrosis, hematoma following liver trauma, and rarely polycystic liver disease.69 In a small group of cases the origin of the abscess is unknown or cryptogenic.
The liver
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The aetiology of a pyogenic liver abscess is unexplained in the majority of patients. Common causes include biliary stone disease and other causes of intra-abdominal sepsis, including appendicitis and diverticular disease. It has an increased incidence in the elderly, diabetics and the immunosuppressed, who usually present with anorexia, fevers and malaise, accompanied by right upper quadrant discomfort. The diagnosis is suggested by the finding of a multiloculated cystic mass on ultrasound or CT scan (Figure65.17) and is confirmed by aspiration for culture and sensitivity. The most common organisms are Streptococcus milleri and Escherichia coli, but other enteric organisms such as Streptococcus faecalis, Klebsiella and Proteus vulgaris also occur, and mixed growths are common. Opportunistic pathogens include staphylococci. Treatment is with antibiotics and ultrasound-guided aspiration. First-line antibiotics to be used are a penicillin, aminoglycoside and metronidazole or a cephalosporin and metronidazole. Often repeated aspirations may be necessary. Percutaneous drainage without ultrasound guidance should be performed with caution as an empyema may follow drainage through the pleural space. A source for the liver abscess should be sought, particularly from the colon. Atypical clinical or radiological findings should raise the possibility of a necrotic neoplasm.
Infections caused by hypervirulent Klebsiella pneumoniae in non-endemic countries: three case reports and review of the literature
Published in Acta Clinica Belgica, 2023
Wannes Van Hooste, Marthe Vanrentergem, Eric Nulens, Christophe Snauwaert, Deborah De Geyter, Rembert Mertens, Jens T. Van Praet
A 54-year-old Belarusian male truck driver presented at the emergency ward because of diarrhoea in the last 3 days, cough, dyspnoea and fever. He had no relevant medical history and took no medication. Upon clinical examination, he looked severely ill and had fever up to 39°C, but other vital signs were stable. Deep palpation of the abdominal right upper quadrant was painful without muscular rigidity. Further clinical examination was unremarkable. Blood results showed mild neutrophilic leucocytosis (14,900/µl), normal kidney function, significantly raised C-reactive protein (CRP) (378 mg/dl), hyperbilirubinemia (3.30 mg/dL [reference value 0.30–1.20 mg/dl], with a direct bilirubin of 1.1 mg/dl) and minimally elevated AST (58 U/l) and ALT levels (91 U/l). Cholestatic parameters were normal on admission. As screening test for Covid-19, a chest CT without intravenous contrast was performed which visualised an atypical lesion in segment 6 of the partially displayed liver. After taking blood cultures, empiric antibiotic treatment (amoxicillin/clavulanic acid 1000 mg/200 mg every 6 hours IV) was initiated. Additional investigation with triple-phase CT of the liver showed an ill-defined, thin-walled and heterogeneous lesion with a diameter of 9 cm in the right liver lobe (see Figure 1, panel A-D). There was some heterogeneous enhancement after intravenous contrast administration, mostly sparing the outer rim. The differential diagnosis at this point included a pyogenic liver abscess, amoebic liver abscess or multilocular liver tumour.
Breaking Bad: a case of Lactobacillus bacteremia and liver abscess
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Abdillahi M. Omar, Nastaran Ahmadi, Mutaz Ombada, Joseph Fuscaldo, Nazia Siddiqui, Myra Safo, Swaroopa Nalamalapu
When evaluating a patient with a liver abscess, the most common etiology is a pyogenic liver abscess accounting for 48% of visceral abscesses and 13% of intra-abdominal abscesses overall [18]. It has similar risk factors to Lactobacillus liver abscess such as diabetes, hepatopancreaticobiliary, and intracolonic disease. Important microbiological causes of pyogenic liver abscess include gram-negative bacilli (Escherichia coli, Klebsiella pneumonia) and streptococci [19]. Therefore, when presented with a patient with a liver abscess, a pyogenic liver abscess should be strongly considered and treated empirically covering the most common bacteria.
Successful laparoscopic management of a hepatic abscess caused by a fish bone
Published in Acta Chirurgica Belgica, 2021
G. Beckers, J.-Ph. Magema, V. Poncelet, T. Nita
Hepatic abscess is a rare (2.3 per 100,000 population) but severe condition with a high morbidity and mortality rate [1,2]. Even though this condition has been known and studied since Hippocrates (around 400 BC) [3], the diagnostic and treatment remains a challenge. There are various etiologies to this pathology (traumatic, arterial hematogenous spread, biliary tract,…) each of which requires a specific therapeutic approach [4]. The case we describe is a pyogenic liver abscess supposedly caused by the perforation of the gastro-intestinal tract by an ingested foreign body, a rare but possibly lethal etiology.