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Pseudomonas pseudomallei liver abscesses: a clinical, laboratory, and ultrasonographic study
T Vatcharapreechasakul1, Y Suputtamongkol, D A Dance
1Sappasitprasong Hospital, Ubon Ratchatani, Bangkok, Thailand.
Abstract:
Ultrasonography revealed evidence of liver abscess in 126 patients who were admitted to one hospital in northeastern Thailand over a 3-year period. There were 50 cases for which a pyogenic bacterial etiology was confirmed; 34 cases (group 1) were caused by Pseudomonas pseudomallei (nine patients died) and 16 cases (group 2) were caused by other bacteria (two patients died). Melioidosis was associated with anemia and underlying diabetes or renal disease; right-upper-quadrant pain and jaundice were more common in group 2 (P less than .05). Blood cultures were positive for bacteria in 68% of group 1 and 50% of group 2. Chest radiographs revealed abnormalities in 17 of 30 group 1 patients and 6 of 12 group 2 patients. The radiographic appearances of a blood-borne pneumonia suggested melioidosis. The serum indirect hemagglutination assay for antibodies to P. pseudomallei was of limited value in differentiating the two types of abscesses. Multiple hypoechoic areas on ultrasonography were significantly associated with melioidosis (P less than .01); associated splenic abscess occurred in 19 group 1 patients but only one group 2 patient (2-107, 95% confidence interval; odds ratio, 19). In an area where P. pseudomallei is endemic, these characteristic ultrasonographic findings should prompt immediate treatment for melioidosis.
Insights
Ultrasonography can identify liver abscesses caused by Pseudomonas pseudomallei (melioidosis) and other bacteria. Characteristic ultrasound findings, like multiple hypoechoic areas, suggest melioidosis, enabling prompt treatment.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Hepatology
Background:
- Liver abscesses are serious infections requiring accurate diagnosis.
- Distinguishing between pyogenic bacterial causes, particularly melioidosis, is crucial for effective treatment.
- Pseudomonas pseudomallei is an endemic pathogen in certain regions, causing melioidosis.
Purpose of the Study:
- To evaluate the role of ultrasonography in diagnosing liver abscesses.
- To differentiate between melioidosis and other pyogenic bacterial liver abscesses using imaging findings.
- To identify ultrasonographic features associated with Pseudomonas pseudomallei liver abscesses.
Main Methods:
- Retrospective analysis of 126 patients with liver abscesses diagnosed via ultrasonography over three years.
- Categorization of cases into Pseudomonas pseudomallei (melioidosis) and other bacterial etiologies.
- Correlation of ultrasonographic findings with clinical data, blood cultures, chest radiographs, and serological assays.
Main Results:
- Ultrasonography identified liver abscesses in 126 patients; 50 had confirmed bacterial etiology.
- Pseudomonas pseudomallei caused 34 cases (group 1, 9 deaths), other bacteria caused 16 cases (group 2, 2 deaths).
- Multiple hypoechoic areas on ultrasound were significantly associated with melioidosis (P < .01), as was splenic abscess (OR, 19).
Conclusions:
- Characteristic ultrasonographic findings, including multiple hypoechoic areas and splenic abscess, strongly suggest melioidosis in endemic areas.
- Ultrasonography is a valuable tool for differentiating melioidosis liver abscesses from those caused by other bacteria.
- Prompt recognition of these ultrasound features can guide immediate treatment for melioidosis.