Infectious Disease Compendium

Liver 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.

C. albicans and other fungi can occur in the neutropenic and if aspergillus occurs in a young person for no reason, think of Chronic Granulomatous Disease.

Diabetics are also at risk especially Klebsiella (PubMed).

PPI's increase the risk of liver abscess and mortality (PubMed).

Microbiology

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

Mono-bacterial infections with Klebsiella pneumoniae (the hyperviscous kind) is not uncommon, especially in diabetics (PubMed). About 10% of Klebsiella liver abscess will have a metastatic complication, most often eyes and lung (PubMed). There may be an association between Klebsiella liver abscesses and malignancy (PubMed).

Amoebic: E. histolytica.

Candida: Hmmmm. Candida? Yep. Candida, especially C. albicans after a prolonged course of neutropenic fever.

AIDS: Bartonella (aka cat scratch disease), especially in HIV disease.

There is a syndrome of aseptic liver abscesses, an autoimmune disease most often associated with IBD and related to Sweets, pyoderma gangrenosum and Beh├žet disease (PubMed).

Empiric Therapy

I prefer a third generation cephalosporins PLUS metronidazole. Alternatives include a carbapenem OR penicillin/beta-lactamase inhibitors OR a quinolone PLUS metronidazole. Clindamycin can be substituted for the metronidazole.

Drain (if < 2 cm, probably can take care of it medically) PLUS antibiotics if bacterial, antibiotics alone if amoebic, if Candida, probably lipid based amphotericin B.

Pearls

Patients with CGD associated liver abscesses do better with steroids (PubMed).

Rants

Curious Cases

Relevant links to my Medscape blog

Expect What?

My liver quivers.

A Blast from the Past?

It's Been A Long Time

Relapse or ReInfection

You Heard It Here First

Good time are slowing fading away

Rearrange Your Liver

I Love Me a Good Gram Stain

More Snot in the Wrong Place

Great Ideas Disproved by Reality Yet Again

Five Year Fester

Good Bye Mr. Chips

Increased Retention

Probably Not Relevant But Fun to Think About

A Gamble That Paid Off

Discordant

Threes

String Theory

But Wait. There's More.

Why We Have Radiologists

Last Update: 07/15/18.