1/4. Pyogenic liver abscess with a focus on klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics.OBJECTIVES: Pyogenic liver abscess is a common intraabdominal infection. Historically, escherichia coli (E. coli) has been the predominant causative agent. Klebsiella liver abscess (KLA) was first reported in taiwan and has surpassed E. coli as the number one isolate from patients with hepatic abscesses in that country and reports from other countries, including the united states, have increased. We examined the microbiologic trends of pyogenic liver abscess at our institution to determine if a similar shift in etiologic agents was occurring. methods: We examined all cases of liver abscess at our institution from 1999 to 2003 via a retrospective chart review of inpatient records and reviewed the English literature via a medline search for all U.S. cases of KLA. RESULTS: Since 1966, only 12 cases of KLA have been reported in the united states. We report six cases of KLA at our institution alone; 2 patients were not Asian, and 4 were not diabetic. klebsiella pneumoniae (K. pneumoniae) was the most common cause of pyogenic hepatic abscess at our institution over the last 5-yr period. When comparing Klebsiella versus other causes of pyogenic liver abscess, there were no significant differences in demographics or laboratory findings; however, most of our Klebsiella cases occurred among Filipinos. review of the 18 cases of K. pneumoniae liver abscess in the united states showed that Klebsiella cases occurred predominantly among middle-aged men; 83% had concurrent bacteremia and 28% had metastatic complications. An increasing number of cases were reported from the united states since the mid-1990s. CONCLUSIONS: These data suggest that KLA may represent an emerging disease in Western countries, such as the united states. The diagnosis of K. pneumoniae should be considered in all cases of liver abscess, and appropriate antibiotic therapy and a diagnostic work-up for metastatic complications should be employed.- - - - - - - - - - ranking = 1keywords = pneumoniae (Clic here for more details about this article) |
2/4. Two cases of klebsiella pneumoniae primary liver abscesses; an emerging clinical entity among diabetics.klebsiella pneumoniae liver abscesses with limited antibiotic resistance have been increasing among diabetics in various geographic regions, most notably in taiwan. Two cases of Hawaiian diabetic men with klebsiella pneumoniae primary liver abscesses are presented as well as a brief review of the literature.- - - - - - - - - - ranking = 0.75keywords = pneumoniae (Clic here for more details about this article) |
3/4. Pyogenic liver abscess caused by burkholderia pseudomallei in taiwan.Pyogenic liver abscess in taiwan is a well-known disease entity, commonly associated with a single pathogen, klebsiella pneumoniae. melioidosis is an endemic disease in taiwan that can manifest as multiple abscesses in sites including the liver. We report three cases of liver abscesses caused by burkholderia pseudomallei. The first patient was a 54-year-old diabetic woman, who presented with liver abscess and a left subphrenic abscess resulting from a ruptured splenic abscess, co-infected with K. pneumoniae and B. pseudomallei. The second patient, a 58-year-old diabetic man, developed bacteremic pneumonia over the left lower lung due to B. pseudomallei with acute respiratory distress syndrome, and relapsed 5 months later with bacteremic abscesses of the liver, spleen, prostate and osteomyelitis, due to lack of compliance with prescribed antibiotic therapy. The third patient was a 61-year-old diabetic man with a history of travel to thailand, who presented with jaundice and fever of unknown origin. Liver and splenic abscesses due to B. pseudomallei were diagnosed. A high clinical alertness to patients' travel history, underlying diseases, and the presence of concomitant splenic abscess is essential to early detection of the great mimicker, melioidosis. The treatment of choice is intravenous ceftazidime for at least 14 days or more. An adequate duration of maintenance oral therapy, with amoxicillin-clavulanate or trimethoprim-sulfamethoxazole for 12-20 weeks, is necessary to prevent relapse. liver abscess in taiwan is most commonly due to K. pneumoniae, but clinicians should keep in mind that this may be a presenting feature of melioidosis.- - - - - - - - - - ranking = 0.375keywords = pneumoniae (Clic here for more details about this article) |
4/4. Pyogenic liver abscess after choledochoduodenostomy for biliary obstruction caused by autoimmune pancreatitis.A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagnosed. The renal tumor was diagnosed as a renal cell cancer. Steroid therapy was started and thereafter pancreatic inflammation improved. Five years after surgery, the patient was readmitted because of pyrexia in a preshock state. A klebsiella pneumoniae liver abscess complicated by sepsis was diagnosed. The patient recovered with percutaneous abscess drainage and administration of intravenous antibiotics. liver abscess recurred 1 mo later but was successfully treated with antibiotics. There has been little information on long-term outcomes of patients with AIP treated with surgery. To our knowledge, this is the second case of liver abscess after surgical treatment of AIP.- - - - - - - - - - ranking = 0.125keywords = pneumoniae (Clic here for more details about this article) |