In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle asp...In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur....BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.展开更多
BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli...BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,the χ^(2) test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.展开更多
AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records...AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were reviewed.Amoebic and hydatid abscesses were excluded.Demographic,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were recorded.RESULTS:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) d.Only 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was measured.Liver function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) cm.Causative organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial infarction.The initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their hospitalization.Serum hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION:PLA is a diagnostic challenge,because the presentation of this condition is non-specific.Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.展开更多
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to ...AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.展开更多
AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic l...AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and out-come of surgery. RESULTS:The patients were predominantly women (10/13) with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multilocula-tion. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with perito-nitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism. CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.展开更多
BACKGROUND: Etiologic organism is not frequently isolated despite multiple blood and lfuid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogen-ic liver abscess (CNPLA) is routinely...BACKGROUND: Etiologic organism is not frequently isolated despite multiple blood and lfuid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogen-ic liver abscess (CNPLA) is routinely managed by antibiotics targeted toKlebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice. METHODS: All the patients with CNPLA andKlebsiella pneu-moniaePLA (KPPLA) admitted from January 2003 to Decem-ber 2011 were included in the study. A retrospective review of medical records was performed and demographic, clinical and outcome data were collected. RESULTS: A total of 528 patients were treated as CNPLA or KPPLA over the study period. CNPLA presented more com-monly with abdominal pain (P=0.024). KPPLA was more com-mon in older age (P=0.029) and was associated with thrombo-cytopenia (P=0.001), elevated creatinine (P=0.002), bilirubin (P=0.001), alanine aminotransferase (P=0.006) and C-reactive protein level (P=0.036). CNPLA patients tend to have anemia (P=0.015) and smaller abscess (P=0.008). There was no differ-ence in hospital stay (15.7 vs 16.8 days) or mortality (14.0% vs 11.0%). No patients required surgical drainage after initiation of medical therapy. CONCLUSION: Despite demographic and clinical differences between CNPLA and KPPLA, overall outcomes are not different.展开更多
BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecula...BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.展开更多
Pyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogen...Pyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus （DM）. The pathogen in the patient with DM was Klebsiella pneumonia （KP）. In both of the patients, Ueus developed about two to three weeks after the diagnosis of liver abscess. Colonoscopy revealed large polypoid tumors with pathological findings of tubulovillous adenoma in both cases. Two lessons were learned from these two cases： （1） an underlying cause should be aggressively investigated in patients with cryptogenic liver abscess; （2） DM could be one of the etiologies but not necessarily the only cause of KP liver abscess.展开更多
AIM: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN). METHODS: We performed a retrospective analysis involving patients with PLA. The demograp...AIM: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN). METHODS: We performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management and outcome of patients with and without HN were studied. RESULTS: From January 2000 to December 2009 inclusive, 318 patients (35 with HN) had PLA, and mean age and comorbidity were comparable between the two groups. More patients with HN experienced right upper quadrant pain (68.6% vs 52.7%, P < 0.04), developed jaundice (14.3% vs 5.7%, P < 0.03) and hepatomegaly (17.1% vs 3.9%, P < 0.01), and had higher serum total bilirubin level (43.3 μmol/L vs 30.0 μmol/L, P = 0.05). Most patients in both groups had PLAs in the right hepatic lobe, and biliary tract disorder was the most common underlying cause (71.4% and 61.8%). However, more PLAs in the HN group were associated with thicker abscess wall (37.1% vs 19.4%, P < 0.01), septal lobulation (77.1% vs 58%, P < 0.02), gaseous cavitation (17% vs 7.8%, P = 0.03), portal thrombophlebitis (11.4% vs 1.8%, P < 0.01) and aerobilia (25.9% vs 5.5%, P < 0.01). Mixed bacterial growth (40% vs 15.2%, P < 0.01) and Gram-negative bacilli (22.8% vs 60.4%, P < 0.01) were dominant isolates in PLAs with and without HN, respectively. Although incidence of the complications was comparable between the two groups, patients with HN had a higher mortality rate than those without (71.4% vs 8.8%, P < 0.01). Multivariate logistic regression analysis revealed underlying active malignancy [odds ratio (OR): 40.45, 95% CI: 14.76-111.65], hypoalbuminemia (OR: 1.22, 95% CI: 1.14-1.38), disseminated intravascular coagulation (OR: 3.32, 95% CI: 1.19-9.69) and acute coronary syndrome (OR: 4.48, 95% CI: 1.08-17.8) were independent risk factors associated with mortality. However, several HN cases, presented concurrently with PLAs, were found to have curative resectable tumors and had good prognosis after surgery. CONCLUSION: PLA associated with HN tends to form a distinct clinical syndrome with a different extent of clinical manifestations, radiological and microbiological features and complications.展开更多
BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We re...BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.展开更多
This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses(PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitation...This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses(PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitations and potential clinical implications of this study. Issues of the mucosal barrier, the microbial flora, administration of antibiotics and underlying diseases are discussed. The probability of PLAs after endoscopies is not exactly known and the length of the "incubation period" remains unclear, but a possible causality should already suffice to make us think how to avoid them. Especially in patients with risk factors such as diabetes mellitus, end-stage renal disease, liver cirrhosis, biliary tract infection, and malignancies, the potential risk for PLAs should be considered. Unnecessary insufflation during endoscopy(causing mucosal stretching and microscopic tears) as well as mucosal damage(by direct abrasion with the scope) should be avoided in order to limit the invasiveness of the procedure as much as possible. And, in everyday routine, it should be kept in mind that in patients after endoscopy, especially in those with a breach of the mucosal barrier and significant comorbidities, PLAs can potentially develop and require timely administration of antibiotics as well as further diagnostic and therapeutic steps.展开更多
BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and...BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.展开更多
BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiolog...BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.展开更多
Introduction: Hemophagocytic lymphohistiocytosis during pregnancy is a rare and severe condition, and timely diagnosis is quite difficult. We present the first case of hemophagocytic lymphohistiocytosis caused by pyog...Introduction: Hemophagocytic lymphohistiocytosis during pregnancy is a rare and severe condition, and timely diagnosis is quite difficult. We present the first case of hemophagocytic lymphohistiocytosis caused by pyogenic liver abscess during pregnancy and discuss the clinical presentation. Case Presentation: A 26-year-old Japanese primigravida at 23 weeks of gestation complained of extremely high fever with a fast heart rate (140 beats per minute). She presented with systemic inflammatory response syndrome (SIRS). Only 2 days later, she died. Autopsy findings proved that this was the first case of hemophagocytic lymphohistiocytosis caused by pyogenic liver abscess during pregnancy. Conclusion: Hemophagocytic lymphohistiocytosis should be considered when patients meet the SIRS criteria, especially whose clinical presentation includes extremely high fever (39°C) and a fast heart rate (greater than 110 bpm) during pregnancy, despite relatively normal laboratory data, because such vital signs may be associated with the onset of hemophagocytic lymphohistiocytosis.展开更多
BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate th...BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.展开更多
AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in ...AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.展开更多
We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. De...We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in plan- ning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyo- genic liver abscess, but is it applicable also for caudate lobe abscess？展开更多
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed...BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.展开更多
Pyogenic liver abscess (PLA) is a potentially life-threatening disease. Early diagnosis and appropriate treatment are crucial to ensure high-quality healthcare for patients with PLA. However, this is complicated by th...Pyogenic liver abscess (PLA) is a potentially life-threatening disease. Early diagnosis and appropriate treatment are crucial to ensure high-quality healthcare for patients with PLA. However, this is complicated by their non-specific clinical symptoms. In addition, the etiologic organisms responsible for PLA are frequently culture-negative, thus complicating clinical decision-making. Here, we report a case of PLA caused by Streptococcus intermedius, as identified via DNA metagenomic sequencing of plasma.展开更多
文摘In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.
文摘BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,the χ^(2) test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.
文摘AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were reviewed.Amoebic and hydatid abscesses were excluded.Demographic,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were recorded.RESULTS:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) d.Only 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was measured.Liver function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) cm.Causative organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial infarction.The initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their hospitalization.Serum hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION:PLA is a diagnostic challenge,because the presentation of this condition is non-specific.Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.
基金Supported by The National Natural Science Foundation of China, No. 30872482 and No. 81072051
文摘AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
文摘AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and out-come of surgery. RESULTS:The patients were predominantly women (10/13) with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multilocula-tion. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with perito-nitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism. CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.
文摘BACKGROUND: Etiologic organism is not frequently isolated despite multiple blood and lfuid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogen-ic liver abscess (CNPLA) is routinely managed by antibiotics targeted toKlebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice. METHODS: All the patients with CNPLA andKlebsiella pneu-moniaePLA (KPPLA) admitted from January 2003 to Decem-ber 2011 were included in the study. A retrospective review of medical records was performed and demographic, clinical and outcome data were collected. RESULTS: A total of 528 patients were treated as CNPLA or KPPLA over the study period. CNPLA presented more com-monly with abdominal pain (P=0.024). KPPLA was more com-mon in older age (P=0.029) and was associated with thrombo-cytopenia (P=0.001), elevated creatinine (P=0.002), bilirubin (P=0.001), alanine aminotransferase (P=0.006) and C-reactive protein level (P=0.036). CNPLA patients tend to have anemia (P=0.015) and smaller abscess (P=0.008). There was no differ-ence in hospital stay (15.7 vs 16.8 days) or mortality (14.0% vs 11.0%). No patients required surgical drainage after initiation of medical therapy. CONCLUSION: Despite demographic and clinical differences between CNPLA and KPPLA, overall outcomes are not different.
基金supported by Hunan Province Key Research and Development Program(2020SKC2004).
文摘BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.
文摘Pyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus （DM）. The pathogen in the patient with DM was Klebsiella pneumonia （KP）. In both of the patients, Ueus developed about two to three weeks after the diagnosis of liver abscess. Colonoscopy revealed large polypoid tumors with pathological findings of tubulovillous adenoma in both cases. Two lessons were learned from these two cases： （1） an underlying cause should be aggressively investigated in patients with cryptogenic liver abscess; （2） DM could be one of the etiologies but not necessarily the only cause of KP liver abscess.
文摘AIM: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN). METHODS: We performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management and outcome of patients with and without HN were studied. RESULTS: From January 2000 to December 2009 inclusive, 318 patients (35 with HN) had PLA, and mean age and comorbidity were comparable between the two groups. More patients with HN experienced right upper quadrant pain (68.6% vs 52.7%, P < 0.04), developed jaundice (14.3% vs 5.7%, P < 0.03) and hepatomegaly (17.1% vs 3.9%, P < 0.01), and had higher serum total bilirubin level (43.3 μmol/L vs 30.0 μmol/L, P = 0.05). Most patients in both groups had PLAs in the right hepatic lobe, and biliary tract disorder was the most common underlying cause (71.4% and 61.8%). However, more PLAs in the HN group were associated with thicker abscess wall (37.1% vs 19.4%, P < 0.01), septal lobulation (77.1% vs 58%, P < 0.02), gaseous cavitation (17% vs 7.8%, P = 0.03), portal thrombophlebitis (11.4% vs 1.8%, P < 0.01) and aerobilia (25.9% vs 5.5%, P < 0.01). Mixed bacterial growth (40% vs 15.2%, P < 0.01) and Gram-negative bacilli (22.8% vs 60.4%, P < 0.01) were dominant isolates in PLAs with and without HN, respectively. Although incidence of the complications was comparable between the two groups, patients with HN had a higher mortality rate than those without (71.4% vs 8.8%, P < 0.01). Multivariate logistic regression analysis revealed underlying active malignancy [odds ratio (OR): 40.45, 95% CI: 14.76-111.65], hypoalbuminemia (OR: 1.22, 95% CI: 1.14-1.38), disseminated intravascular coagulation (OR: 3.32, 95% CI: 1.19-9.69) and acute coronary syndrome (OR: 4.48, 95% CI: 1.08-17.8) were independent risk factors associated with mortality. However, several HN cases, presented concurrently with PLAs, were found to have curative resectable tumors and had good prognosis after surgery. CONCLUSION: PLA associated with HN tends to form a distinct clinical syndrome with a different extent of clinical manifestations, radiological and microbiological features and complications.
文摘BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.
文摘This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses(PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitations and potential clinical implications of this study. Issues of the mucosal barrier, the microbial flora, administration of antibiotics and underlying diseases are discussed. The probability of PLAs after endoscopies is not exactly known and the length of the "incubation period" remains unclear, but a possible causality should already suffice to make us think how to avoid them. Especially in patients with risk factors such as diabetes mellitus, end-stage renal disease, liver cirrhosis, biliary tract infection, and malignancies, the potential risk for PLAs should be considered. Unnecessary insufflation during endoscopy(causing mucosal stretching and microscopic tears) as well as mucosal damage(by direct abrasion with the scope) should be avoided in order to limit the invasiveness of the procedure as much as possible. And, in everyday routine, it should be kept in mind that in patients after endoscopy, especially in those with a breach of the mucosal barrier and significant comorbidities, PLAs can potentially develop and require timely administration of antibiotics as well as further diagnostic and therapeutic steps.
基金Supported by Science and Technology Planning Project of Gansu Province,No.21CX6FD163Science and Technology Planning Project of Baiyin City,No.2021-1-18Y.
文摘BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.
文摘BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.
文摘Introduction: Hemophagocytic lymphohistiocytosis during pregnancy is a rare and severe condition, and timely diagnosis is quite difficult. We present the first case of hemophagocytic lymphohistiocytosis caused by pyogenic liver abscess during pregnancy and discuss the clinical presentation. Case Presentation: A 26-year-old Japanese primigravida at 23 weeks of gestation complained of extremely high fever with a fast heart rate (140 beats per minute). She presented with systemic inflammatory response syndrome (SIRS). Only 2 days later, she died. Autopsy findings proved that this was the first case of hemophagocytic lymphohistiocytosis caused by pyogenic liver abscess during pregnancy. Conclusion: Hemophagocytic lymphohistiocytosis should be considered when patients meet the SIRS criteria, especially whose clinical presentation includes extremely high fever (39°C) and a fast heart rate (greater than 110 bpm) during pregnancy, despite relatively normal laboratory data, because such vital signs may be associated with the onset of hemophagocytic lymphohistiocytosis.
文摘BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.
文摘AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.
文摘We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in plan- ning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyo- genic liver abscess, but is it applicable also for caudate lobe abscess？
文摘BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
文摘Pyogenic liver abscess (PLA) is a potentially life-threatening disease. Early diagnosis and appropriate treatment are crucial to ensure high-quality healthcare for patients with PLA. However, this is complicated by their non-specific clinical symptoms. In addition, the etiologic organisms responsible for PLA are frequently culture-negative, thus complicating clinical decision-making. Here, we report a case of PLA caused by Streptococcus intermedius, as identified via DNA metagenomic sequencing of plasma.
