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Presentations of pyogenic liver abscess in one UK centre over a 15-year period

N C Bosanko1, A Chauhan, M Brookes

  • 1Sandwell and West Birmingham NHS Trust, Birmingham, UK. nickbosanko@doctors.net.uk

The Journal of the Royal College of Physicians of Edinburgh
|March 3, 2011
PubMed

Insights

Pyogenic liver abscess (PLA) is often diagnosed late, despite common symptoms. Early investigation is crucial, as mortality is linked to sepsis or malignancy.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Internal Medicine

Background:

  • Pyogenic liver abscess (PLA) is a serious condition with historically high mortality rates.
  • Advances in antibiotic therapy and percutaneous drainage have improved outcomes.
  • Understanding contemporary presentation, diagnosis, and management is vital for optimizing patient care.

Purpose of the Study:

  • To identify the typical presenting features of pyogenic liver abscess.
  • To analyze the diagnostic process, microbiology, treatment strategies, and patient outcomes.
  • To evaluate the 15-year experience with PLA management at an inner-city hospital.

Main Methods:

  • Retrospective analysis of patient records with a discharge diagnosis of PLA.
  • Inclusion criteria based on appropriate discharge diagnosis.
  • Data collection on presenting symptoms, laboratory findings, diagnostic delays, and outcomes.

Main Results:

  • Common symptoms included anorexia, abdominal pain, fever, vomiting, and weight loss.
  • Elevated white cell count, C-reactive protein, alkaline phosphatase, and hypoalbuminemia were frequent.
  • A significant delay in presentation (mean 17.3 days) and low diagnostic consideration (1%) at admission were noted. Hospital mortality was 11%.

Conclusions:

  • PLA is often overlooked at initial presentation, despite characteristic symptoms.
  • Early recognition and investigation are essential for timely management.
  • Lower microbiological yield may be due to early empirical antibiotic use; percutaneous drainage and antibiotics remain key, with sepsis and malignancy predicting mortality.
Abstract

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