Single and Multiple Pyogenic Liver Abscesses: Clinical Course, Etiology, and Results of Treatment

Abstract

A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.

Liver abscess in children: challenges in management

“…This is somewhat lesser as compared from other studies-both from developing and the developed world, where the age group is about 8-10 years. [8][9][10][11] USG has been the mainstay of diagnosis of LA. 12,13 The ultrasonic appearance of a typical liver abscess has been described as having the following criteria: acoustic enhancement, abscess wall, peripheral halo, septation, and internal debris.…”

Cellobiose-Specific Phosphotransferase System of Klebsiella pneumoniae and Its Importance in Biofilm Formation and Virulence

“…This emerging disease often presents in association with meningitis and endophthalmitis (35). Despite the improvement of detection methods and medical care, PLA is still a critical disease with high mortality rates (10% to ϳ40%) (7,8,24). Some virulence factors have been identified in a PLA-associated K. pneumoniae strain, including capsular polysaccharide (CPS), iron acquisition systems, and cadC (16,21,22,29), yet the pathogenesis of PLA caused by K. pneumoniae is still unclear.…”

Outcome of ultrasound guided pigtail catheter drainage of liver abscesses a prospective study of 126 cases

“…25,26 However, Asian series have reported Klebsiella to be the most frequently isolated bacteria. [27][28][29][30] CECT abdomen was performed in 13 cases in present series and showed no additional benefit. Amoebic serology was performed, because of endemicity of amoebiasis in our region and because of financial constraints, as most of our patens belonged to poor economic status, comparable with the available studies.…”