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Therapy of Liver Abscesses
Christoph Lübbert1, Johannes Wiegand2, Thomas Karlas2
1Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
Background:
Liver abscess (LA) is an uncommon but potentially life-threatening disease with significant morbidity and mortality.
Methods:
This review comprehensively describes epidemiology, pathogenesis, diagnosis, and treatment of LA, with a strong focus on antimicrobial treatment choices and the impact of multidrug-resistant pathogens.
Results:
In industrialized areas, pyogenic liver abscess (PLA) accounts for over 80% of the cases, whereas Entamoeba histolyticais responsible for up to 10% of the cases, with a higher incidence in tropical areas. Highly virulent strains of Klebsiella pneumoniaehave emerged as a predominant cause of PLA in Asian countries and tend to spread to the USA, Australia, and European countries, therefore requiring special alertness. Most common symptoms of LA are fever, chills, and right upper quadrant abdominal pain, although a broad spectrum of non-specific symptoms may also occur.
Conclusion:
Imaging studies (ultrasound, computed tomography scan) and microbiological findings play a crucial role in the diagnosis of LA. The treatment of choice for PLA is a multimodal approach combining broad-spectrum antibiotics and aspiration or drainage of larger abscess cavities. Amebic LA can be cured by metronidazole therapy without drainage.
Insights
Liver abscess (LA) is a serious condition. This review covers LA causes, diagnosis, and treatment, emphasizing antibiotic choices and drug-resistant bacteria, crucial for effective patient management.
Area of Science:
- Hepatology
- Infectious Diseases
- Microbiology
Background:
- Liver abscess (LA) is a rare but severe condition with high morbidity and mortality.
- Pyogenic liver abscess (PLA) is most common in industrialized regions, while amebic LA occurs more in tropical areas.
- Emerging highly virulent Klebsiella pneumoniae strains are a growing concern, spreading globally.
Purpose of the Study:
- To provide a comprehensive review of liver abscess epidemiology, pathogenesis, diagnosis, and treatment.
- To highlight antimicrobial treatment strategies and the challenges posed by multidrug-resistant pathogens.
- To inform clinical practice regarding the management of liver abscesses.
Main Methods:
- Systematic literature review of epidemiology, pathogenesis, diagnosis, and treatment of liver abscess.
- Focus on antimicrobial therapy, including choices and resistance patterns.
- Analysis of diagnostic imaging and microbiological findings.
Main Results:
- Pyogenic liver abscess (PLA) comprises over 80% of cases; amebic LA accounts for up to 10%.
- Klebsiella pneumoniae is a predominant pathogen in Asia, with increasing global spread.
- Common symptoms include fever, chills, and abdominal pain; diagnosis relies on imaging and microbiology.
Conclusions:
- Diagnosis of LA requires imaging (ultrasound, CT) and microbiological confirmation.
- Optimal PLA treatment involves antibiotics and abscess drainage.
- Amebic LA is effectively treated with metronidazole, often without drainage.
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