Infectious Disease Compendium

Hepatic Abscess

Diagnosis

Fever, RUQ pain and pus in the liver on CT or US.

Epidemiologic Risks

Most occur from underlying biliary disease of any kind, other causes include downstream from colon pathology (esp appendicitis), hematogenous, and bad luck. Candida and other fungi can occur in the neutropenic and will manifest as post-leukocytosis and fever see neutropenic fever

Microbiology

Pyogenic: often mixed: E. coli + Streptococci (esp milleri) + anaerobes. Occasionally S. aureus. Amoebic: E. histolytica.

Candida: Hmmmm. Candida? Yep. Candida, esp C. albicans as a cause of post neutropenic fever leukocytosis and fever.

AIDS: Bartonella (aka cat scratch disease).

Empiric Therapy

Drain the pus plus antibiotics if bacterial, antibiotics alone if amoebic, if Candida, probably lipid based amphotericin.

I prefer a third generation cephalosporins PLUS metronidazole. Alternatives include a carbapenam alone OR penicillin/beta-lactamase inhibitors alone OR a quinolone PLUS metronidazole. In place of metronidazole, clindamycin can be used.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

liver 572.0; amebic 006.3.