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Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients
Abstract:
Changes in the etiology, clinical features, methods of diagnosis, and treatment of pyogenic liver abscess have occurred slowly but continuously over the past century. The earlier changes are well documented in the literature, and continuing variations in the classic patterns of disease are now evident. These include 1) a recent increase in incidence reflecting more accurate diagnostic techniques; 2) changes in bacteriology with a high incidence of Klebsiella infection; 3) a reduction in mortality, reflecting earlier diagnosis and more refined therapeutic methods; and 4) changes in the population at risk namely a large population of terminal cancer patients. Thirty-eight patients treated at the Mount Sinai Hospital over the past 16 years, 1967-1982, have been divided into two groups, each of 8 years duration, reflecting an earlier era before routine use of scanning procedures, and a later period when technetium, gallium, sonographic, and more recently CT imaging procedures were regularly done. During the latter period there was a significant increase in both the total number of liver abscesses diagnosed and in the number estimated as a proportion of all hospital admissions. Mortality has continued to fall to more acceptable levels with a 25% reduction overall. In the early era, extrahepatic intra-abdominal infection caused all four deaths. In the past 8 years obstructing or metastatic cancer has caused four of the five deaths. Bacteremia occurred in six of the nine deaths, five of these being of biliary origin. The decrease in mortality may reflect earlier diagnosis, an increase in the number of solitary abscesses, and better therapy.
Insights
Pyogenic liver abscesses are increasingly diagnosed due to advanced imaging. Mortality has significantly decreased owing to earlier detection and improved treatments, despite shifts in patient demographics and causative bacteria.
Area of Science:
- Hepatology
- Infectious Diseases
- Medical Diagnostics
Background:
- Pyogenic liver abscesses (PLA) exhibit evolving patterns in cause, presentation, diagnosis, and treatment over time.
- Recent shifts include increased incidence, altered bacteriology (notably Klebsiella), reduced mortality, and a changing patient demographic with more cancer patients.
Purpose of the Study:
- To analyze the changes in pyogenic liver abscesses over a 16-year period (1967-1982) at Mount Sinai Hospital.
- To compare outcomes between an earlier era (pre-imaging) and a later era (post-imaging techniques).
Main Methods:
- Retrospective review of 38 patients with pyogenic liver abscesses treated between 1967 and 1982.
- Division of patients into two 8-year cohorts: before and after routine use of advanced imaging (technetium, gallium, sonography, CT).
Main Results:
- A significant increase in diagnosed PLA and their proportion of hospital admissions was observed in the later imaging era.
- Overall mortality decreased by 25%, with deaths in the later era more frequently associated with cancer.
- Klebsiella infection was noted as a common cause, and bacteremia was prevalent in fatal cases, often of biliary origin.
Conclusions:
- Advanced diagnostic imaging has led to earlier detection and increased diagnosis of pyogenic liver abscesses.
- Improved therapeutic methods and earlier diagnosis have substantially reduced mortality rates.
- Shifting patient populations, particularly those with terminal cancer, influence the presentation and outcomes of pyogenic liver abscesses.