Causative agents of liver abscess in those with liver cirrhosis: a 10-year case review of hospitalized patients in Thailand

Abstract

Although patients with cirrhosis of the liver show relative immunosuppression and therefore have increased susceptibility to most infections, they rarely develop liver abscesses. In a retrospective case review, the pathogens causing the liver abscesses observed, between January 1992 and December 2001 at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 44 hospitalized patients diagnosed as cases of liver cirrhosis were investigated. The most common clinical symptoms and signs of the abscesses--abdominal pain (80%), fever and chills (73%), and abdominal tenderness (73%)--were similar to those seen in non-cirrhotic patients with abscesses. The frequency of liver abscess among the cirrhotic patients was low (0.46%). Most (71%) of the abscesses were in the right lobe and most (71%) of those with abscesses only had a single abscess. Surprisingly, many of the abscesses (36%) were apparently caused by amoebae. Bacterial pathogens were identified in eight patients (18%) by blood culture and 15 (34%) patients by pus culture. Seven (16%) of the blood cultures and 13 (30%) of the pus contained Gram-negative aerobes, indicating that such pathogens, particularly Klebsiella pneumoniae (in six pus and six blood cultures) and Escherichia coli (in three pus cultures and one blood), were the most common causes of the bacterial abscesses. Pus culture appeared more successful than blood culture for bacterial abscesses, and amoebic abscesses could always be identified by direct microscopical examination of pus samples. Aspiration of liver abscesses, to obtain pus samples for culture and microscopy, is therefore recommended.

Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model

“…[1][2][3][4] Its emergence in western countries has also been reported. [5][6][7] Previous studies in Taiwan, Singapore and Korea found a high prevalence of the capsular polysaccharide (CPS) K antigen serotypes K1 (54.5-63.4%) and K2 (5-21.2%) of K. pneumoniae in liver abscess isolates.…”

A rare case of extraintestinal amebiasis

“…Amoebiasis of the genitourinary system is a rare parasitic disease [ 17 ]. The rupture of an infected liver abscess around the kidney, through the blood circulation or from the lymphatic system of the kidney and urinary system are the two main routes of transmission of genitourinary amoebiasis [ 18 , 19 ]. Free-living amoeba causes two rare central nervous system infections: primary amoebic meningoencephalitis and granulomatous amoebic encephalitis [ 20 ].…”

A liver abscess presenting as bowel obstruction and perforation

“…They often can be attributed to bacterial infections of the biliary tree such as cholangitis,9 or more distally in the body such as diverticulitis or inflammatory bowel disease,10 where infection may migrate to the liver via the portal vein system. Bacterial endocarditis, dental infections, fungal infections, cirrhosis,11 blunt trauma12 and foreign bodies13 are other causes. No cause is found in up to 15% of cases.…”