Abstract
Pyogenic liver abscess is an uncommon but potentially fatal disease. The accuracy of diagnosis made on clinical grounds can now be greatly improved with the use of modern organ-imaging techniques. The condition is often polymicrobial:Escherichia coli and other enteric gram-negative rods are major pathogens, with anaerobic gram-negative rods andStreptococcus milleri being increasingly recognised. Staphylococcal liver abscesses are less common, often arising in association with neutrophil disorders. Open surgical drainage along with antimicrobial chemotherapy has long been regarded as standard treatment, however, in many centres it is being displaced by percutaneous drainage under the guidance of computed tomography or ultrasound. Some patients have been successfully treated with antimicrobial chemotherapy alone. Once specimens have been taken for culture, empiric antimicrobial therapy should include a combination of an anti-anaerobe agent, an aminoglycoside and a beta-lactam drug such as ampicillin. Early diagnosis and treatment of this condition is essential for patient survival.
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Altemeier, W. A., Schowengerdt, C. G., Whitley, D. A.: Abscesses of the liver: surgical considerations. Archives of Surgery 1970, 101: 258–266.
Heymann, A. D.: Clinical aspects of grave pyogenic abscesses of the liver. Surgery, Gynecology and Obstetrics 1979, 149: 209–213.
Satiani, B., Davidson, E.: Hepatic abscesses: improvement in mortality with early diagnosis and treatment. American Journal of Surgery 1978, 135: 647–650.
Wintch, R. W., Reines, H. D., Rambo, W. M.: Liver abscess: a changing entity. American Surgeon 1982, 48: 11–15.
Altemeier, W. A.: Pyogenic liver abscess. In: Schiff, L., Shiff, E. (ed.): Diseases of the Liver. Lippincott, Philadelphia, 1982, p. 1221–1238.
Brodine, W. N., Schwartz, S. I.: Pyogenic hepatic abscess. New York State Journal of Medicine 1973, 73: 1657–1661.
dela Maza, L. M., Naeim, F., Berman, L. D.: The changing etiology of liver abscess. Journal of the American Medical Association 1974, 227: 161–163.
Eisberg, C. A.: Solitary abscess of the liver. Annals of Surgery 1906, 44: 217–235.
Lee, J. F., Black, G. E.: The changing clinical pattern of hepatic abscess. Archives of Surgery 1972, 104: 465–470.
McDonald, A. P., Howard, R. J.: Pyogenic liver abscess. World Journal of Surgery 1980, 4: 369–380.
McDonald, M. I., Corey, R., Gallis, H. A., Durack, D. T.: Single and multiple pyogenic liver abscesses: natural history, diagnosis and treatment with emphasis on percutaneous drainage. Medicine 1984, 63: 291–302.
McFadzean, A. J. S., Chang, K. P. S., Wong, C. C.: Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics. British Journal of Surgery 1953, 41: 141–152.
Ochsner, A., DeBakey, M., Murray, S.: Pyogenic abscess of the liver: an analysis of forty-seven cases with review of the literature. American Journal of Surgery 1938, 40: 292–319.
Perera, M. R., Kirk, A., Noone, P.: Presentation, diagnosis and management of liver abscess. Lancet 1980, ii: 629–632.
Pitt, H. A., Zuidema, G. D.: Factors influencing mortality in the treatment of pyogenic hepatic abscess. Surgery, Gynecology and Obstetrics 1975, 140: 228–234.
Price, J. E., Joseph, W. L., Mulder, D. G.: Diagnosis and treatment of intrahepatic abscess. American Surgeon 1967, 33: 820–825.
Rothenberg, R. E., Linder, W.: The single pyogenic liver abscess. Surgery, Gynecology and Obstetrics 1934, 59: 31–40.
Rubin, R. H., Swartz, M. N., Malt, R.: Hepatic abscess: change in clinical, bacteriologic and therapeutic aspects. American Journal of Medicine 1975, 57: 601–610.
Warren, K. W., Hardy, K. J.: Pyogenic hepatic abscess. Archives of Surgery 1968, 97: 40–45.
Kune, G. A., Judson, R., Hill, P.: Solitary liver abscess: a continuing medicosurgical problem. Medical Journal of Australia 1979, i: 151–153.
Balasegaram, M.: Management of hepatic abscess. Current Problems in Surgery 1981, 18: 285–340.
Sabbaj, J., Sutler, V. L., Finegold, S. M.: Anaerobic pyogenic liver abscess. Annals of Internal Medicine 1972, 77: 629–638.
Northover, J. M. A., Jones, B. J. M., Dawson, J. L., Williams, R.: Difficulties in the diagnosis and management of pyogenic liver abscess. British Journal of Surgery 1982, 69: 48–51.
Chattopadhyay, B.: Pyogenic liver abscess. Journal of Infection 1983, 6: 5–12.
Buchman, T. G., Zuidema, G. D.: The role of computerized tomographic scanning in the surgical management of pyogenic hepatic abscess. Surgery, Gynecology and Obstetrics 1981, 153: 1–9.
Kuligowska, F., Connors, S. K., Shapiro, J. H.: Liver abscess: sonography in the diagnosis and treatment. American Journal of Roentgenology 1982, 138: 253–257.
Rubinson, H. A., Isikoff, M. B., Hill, M. C.: Diagnostic imaging of hepatic abscesses: a retrospective analysis. American Journal of Roentgenology 1980, 135: 735–740.
Neoptolemos, J. P., Macpherson, D. S., Holm, J. et al.: Pyogenic liver abscess: a study of forty-four cases in two centres. Acta Chirurgica Scandinavica 1982, 148: 415–421.
Berger, L. A., Osborne, D. R.: Treatment of pyogenic liver abscesses by percutaneous needle aspiration. Lancet 1982, i: 132–134.
Neoptolemos, J. P., Macpherson, D. S.: Pyogenic liver abscess. British Journal of Hospital Medicine 1981, 26: 47–50.
Colman, G., Williams, R. E. O.: Taxonomy of some human viridans streptococci. In: Wannamaker, L. W., Matsen, J. M. (ed.): Streptococci and streptococcal diseases. Academic Press, New York, 1972, p. 281.
Facklam, R. R.: Streptococci and aerococci. In: Lennette, E. H., Balows, A., Hausier, W. J., Truant, J. P. (ed.): Manual of clinical microbiology. American Society of Microbiology, Washington, D.C., 1980, p. 88–110.
Facklam, R. R.: The major differences in the American and British streptococcus taxonomy schemes with reference toStreptococcus mitteri. European Journal of Clinical Microbiology 1984, 3: 91–93.
Brennan, R. O., Durack, D. T.: The viridans streptococci in perspective. In: Remington, J. S., Swartz, M. N. (ed.): Current clinical topics in infectious diseases. Volume 3. McGraw-Hill, New York, 1984, p. 253.
Patterson, D. K., Ozeran, R. S., Glantz, G. J., Miller, A. B., Finegold, S. M.: Pyogenic liver abscess due to microaerophilic streptococci. Annals of Surgery 1967, 165: 362–376.
Batezman, N. T., Eykyn, S. J., Phillips, I.: Pyogenic liver abscess caused byStreptococcus milleri. Lancet 1975, i: 657–659.
Parker, M. T., Ball, L. C.:Streptococcus milleri as a pathogen for man. In: Parker, M. T. (ed.): Pathogenic streptococci. Reed Books, Surrey UK, 1979, p. 234–235.
Silver, S., Weinstein, A., Cooperman, A.: Changes in the pathogenesis and detection of intrahepatic abscess. American Journal of Surgery 1979, 137: 608–610.
Eykyn, S., Phillips, I.: Pyogenic liver abscess. British Medical Journal 1980, 380: 1617.
Moore-Gillon, J. C., Eykyn, S., Phillips, I.: Microbiology of pyogenic liver abscess. British Medical Journal 1981, 283: 819–821.
Chusid, M. J., Tomasulo, P. A.: Survival of transfused normal granulocytes in a patient with chronic granulomatous disease. Pediatrics 1978, 61: 556–559.
Dougherty, S. H., Peterson, P. K., Simmons, R. L.: Granulocyte transfusion as an adjunctive therapy for qualitative granufocytopenia. Archives of Surgery 1983, 118: 873–874.
Miller, J. H., Greenfield, L. D., Wald, B. R.: Candidiasis of the liver and spleen in childhood. Pediatric Radiology 1982, 142: 375–380.
Editorial: Pyogenic liver abscess. British Medical Journal 1980, 280: 1155–1156.
Gerzof, S. G., Robbins, A. H., Johnson, W. C., Birkett, D. H., Nabseth, D. C.: Percutaneous catheter drainage of abdominal abscesses: a five year experience. New England Journal of Medicine 1981, 305: 653–657.
Greenwood, L. H., Collins, T. L., Yrizarry, J. M.: Percutaneous management of multiple liver abscesses. American Journal of Roentgenology 1982, 139: 390–392.
Haaga, J. R., Weinstein, A. J.: CT-guided percutaneous aspiration and drainage of abscesses. American Journal of Roentgenology 1980, 135: 1187–1194.
Kraulis, J. E., Bird, B. L., Colapinto, N. D.: Percutaneous catheter drainage of liver abscess: an alternative to open drainage? British Journal of Surgery 1980, 67: 400–402.
Mandel, S. R., Boyd, D., Jacques, P. F., Mandell, V., Staab, E. V.: Drainage of hepatic, intraabdominal and mediastinal abscesses guided by computerized axial tomography. American Journal of Surgery 1983, 145: 120–125.
Martin, E. C., Karlson, K. B., Faukuchen, E., Cooperman, A., Casarella, W. S.: Percutaneous drainage in the management of hepatic abscesses. Surgical Clinics of North America 1981, 61: 157–167.
Sheinfeld, A. M., Steiner, A. E., Rivkin, L. B., Dermer, R. H., Shemesh, O. N., Dolberg, M. S.: Transcutaneous drainage of abscesses of the liver guided by computed tomography scan. Surgery, Gynecology and Obstetrics 1982, 155: 662–666.
van Sonnenberg, E., Ferruci, J. T., Mueller, P. R., Wittenberg, J., Simone, J. F., Malt, R. A.: Percutaneous radiographically guided catheter drainage of abdominal abscesses. Journal of the American Medical Association 1982, 247: 190–192.
Herbert, D. A., Rothman, J., Simmons, F., Fogel, D. A., Wilson, S., Ruskin, J.: Pyogenic liver abscesses: successful non-surgical therapy. Lancet 1982, i: 134–136.
Maher, J. A., Reynolds, T. B., Yellin, A. E.: Successful medical treatment of pyogenic liver abscess. Gastroenterology 1979, 77: 618–622.
Reynolds, T. B.: Medical treatment of pyogenic liver abscesses. Annals of Internal Medicine 1982, 96: 373–374.
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McDonald, M.I. Pyogenic liver abscess: Diagnosis, bacteriology and treatment. Eur. J, Clin. Microbiol. 3, 506–509 (1984). https://doi.org/10.1007/BF02013608
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DOI: https://doi.org/10.1007/BF02013608