Occult pyogenic liver abscess in an adolescent with type 2 diabetes

Williams, Regina; Larson, Noelle; Pinsker, Jordan E.

doi:10.1007/s12020-013-0036-6

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…Underlying disease and predisposing host factors that have been proposed to be associated with the development of liver abscess include immunocompromised status (malignancy, malnutrition, and chemotherapy or immunosuppressant user), chronic granulomatous disease, sickle cell disease, diabetes mellitus, biliary tract anomalies, abdominal trauma, certain parasitic infections, systemic sepsis, perforated appendicitis, umbilical infection, and incorrect umbilical venous catheterization (2,10,15,16,(19)(20)(21)(22). Nevertheless, the majority of pyogenic liver abscesses are cryptogenic (2,23).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

et al. 2020

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Background: Liver abscess is an important but relatively rare disease in children. This study investigated the clinical characteristics of eligible patients at a referral tertiary center over the past two decades. Method: A 20-year retrospective study (January 2000-December 2019) enrolled 38 children diagnosed with liver abscess. Demographic data; clinical features; laboratory, imaging, and microbiological findings; management strategy; and outcomes were reviewed from the patients' medical records. Results: Thirty-eight cases of pyogenic liver abscess were identified without a culture-proven amebic or fungal abscess. The mean age of diagnosis was 9.6 ± 6.2 years, and the male-to-female ratio was 1.92: 1. Hemato-oncological (28.9%) and predisposing hepatobiliary diseases (23.7%) were the two most common predisposing factors. Fever (94.7%) was the most common presentation followed by right upper quadrant abdominal pain (42.1%) and pleural effusion (34.2%). Among the laboratory parameters, leukocytosis was common (70.3%), and all patients had elevated serum C-reactive protein levels. Increased serum levels of alanine aminotransferase, aspartate aminotransferase, direct bilirubin, and total bilirubin were found in 40.5, 48.6, 23.1, and 42.9% of the cases, respectively. The most common pathogen in blood and pus cultures was Klebsiella pneumoniae. The mean durations of intravenous antibiotic and total antibiotic use were 29.0 ± 15.7 and 45.1 ± 22.1 days, respectively. Twelve patients (31.6%) were treated with antibiotics alone, while percutaneous needle aspiration, percutaneous pigtail drainage, and surgical intervention were performed in 12 (31.6%), 10 (26.3%), and 5 (13.2%) patients, respectively. No mortality was documented in this series. Conclusion: The present study reflects a relatively declining incidence of liver abscess compared with prior studies in Taiwan. K. pneumoniae remains the most prevalent pathogen in both blood and abscess cultures in Taiwan. Proper antimicrobial therapy with timely drainage generally yielded an adequate treatment response without any mortality.

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Section: Discussionmentioning

confidence: 99%

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

et al. 2020

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“…Percutaneous drainage of the mass revealed an occult pyogenic liver abscess caused by Klebsiella pneumoniae , and intravenous antibiotic treatment was followed by recovery. As reported in other cases, unsatisfactory glycemic control is the most important risk factor ( 83 ).…”

Section: Narrative Reviewmentioning

confidence: 69%

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

et al. 2022

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Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.

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“…DM patients with poor or uncontrolled glycaemia had higher frequency of original or metastatic infections. [ 16 ] It is generally accepted that an increased blood-glucose level can inhibit phagocyte chemotaxis, phagocytosis and bactericidal activity, and contributes to bacterial growth and a compromised host defense system. [ 17 ] The patient in this case had blood-glucose slightly higher than normal level, this may also be a reason why the infection progress so fast.…”

Section: Discussionmentioning

confidence: 99%

Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult

Yang

Shrestha²,

Kolakshyapati

et al. 2018

Medicine

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Rationale:Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety of deep-seated infections with significant morbidities. However, in the current scenario of global rise in antibiotic abuse, unexpected infection could be caused by K. pneumoniae.Patient concerns:A 56-year-old male who presented with intermittent headache and low fever was admitted, he had transsphenoidal surgery for pituitary adenoma 3 years ago. Routine laboratory tests revealed an elevated WBC count of 10.12 × 109/L and C-reactive protein (CRP) 12.9 mg/L. computed tomography (CT) revealed the sellar region with suspicious hemorrhage.Diagnoses:The patient was initially diagnosed with acute residual tumor hemorrhage. But the consequent diagnose of Klebsiella pneumoniae purulent meningitis was made based on the cerebrospinal fluid lab test and cerebrospinal fluid (CSF) and blood culture, and CT scan.Interventions:Lumbar puncture examination was made and the antibiotics were adjusted to meropenem and vancomycin according to the antibiotic sensitivity test. But because of the patient's unstable vital signs, his family refuse further lateral ventricular drainage.Outcomes:The infection was out of control and the patient died of spontaneous breath and heartbeat arrest.Lessons:Through this case, we could learn that any clue of suspicious intracranial infection should be carefully considered in the current scenario of global rise in antibiotic abuse. The manifestation of intermittent headache and mild fever could be potential signs of fatal infection, and prompt appropriate measures should be taken timely.

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Occult pyogenic liver abscess in an adolescent with type 2 diabetes

Cited by 8 publications

References 3 publications

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult

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