Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases

Abstract

SummaryDistinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ. We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies. Presumptive diagnoses of amoebic (n ¼ 471; 82%) vs. pyogenic (n ¼ 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy. Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P ¼ 0.012). Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04). Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection. Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess. In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration.keywords liver abscess, amoebic abscess, pyogenic

Characteristics of Liver Abscess in Department of Infectious Diseases at Fann Teaching University Hospital in Dakar, Senegal

“…Thus, we found that in 90% of cases the abscess was unique. Varying percentages have been reported ranging from 65% to 77% [17] [20] [21]. The right lobe remains the preferred but not exclusive location of liver abscesses [9] [12] [22], which is consistent with our findings where abscesses were present in the right lobe in 95%.…”

Pyogenic Liver Abscess: Prospective Evaluation Of USG Guided Percutaneous Therapeutic Aspiration

“…Earlier studies had reported the mean TLC to be 15000cells/mm3 with the range 7500cells/mm3 to 25000cells/mm3. [8] Majority of our patients (86%) had single liver abscess cavity and 94% of our patients had their right lobe involved (Figure No 2).This finding is similar to other studies where solitary abscess and right lobe involvement were most commonly noted [9,10,12,16,17,18] In our study 68% patients had abscess size between 5-8 cm with a mean of 6.5±1.8 (Table 03).It was similar to other studies [6,15,17,19,20] In our study pus culture were positive in 80% patients with E.Coli in 40% cases, Kleibsiella in 10%, staphylococcus in 24% and mixed organism in 06% cases (table no 04). In our study Kleibsiella incidence was less probably due to exclusion of diabetic patients.…”

“…In 1987 Barnes et al in a study showed that 22% patients with pyogenic liver abscess had jaundice. [14] But the values obtained by Lodhi et al in Pakistan are different from previous studies, they observed that 43% patients with pyogenic liver abscess had jaundice [9]. Thirty six percent patients had nausea and or vomiting ( Figure No.01).…”

“…[6,7] Ninety percent of our patients were male and 10% female .So male : female ratio is 9:1. Reports in the literature show there is a male preponderance in a ratio ranging from 10:1 to 17:1 [8,9,10]. The male preponderance may be due to high percentage of alcohol intake among males and less awareness among females to seek medical advice for illness.…”

Clinical Manifestations and Risk Factors of Amebic Liver Abscess in Southeast Taiwan Compared with Other Regions of Taiwan

“…Although the prevalence of alcoholism and diabetes was higher, some studies indicated that amebic infection may depress the human immune system. 1,18,19 Depressed T-cell activity has been found during acute amoebiasis. 1,19 Some parasitic diseases also stimulate a host's immune system to switch from a Th1 to Th2 response.…”