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Tropical liver abscess

K G Yeoh1, I Yap, S T Wong

  • 1National University Hospital, Singapore Department of Medicine.

Postgraduate Medical Journal
|February 1, 1997
PubMed
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Pyogenic liver abscesses are now more common than amoebic ones in Singapore, often caused by Klebsiella pneumoniae. Percutaneous aspiration is key for diagnosis and treatment, aiding in identifying other conditions.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Microbiology

Background:

  • Liver abscesses present a significant clinical challenge, with varying etiological patterns observed regionally over time.
  • Previous regional studies indicated amoebic abscesses as the predominant type.

Purpose of the Study:

  • To review the changing trends in liver abscess etiology and management at a tertiary care hospital in Singapore.
  • To identify common pathogens, assess antibiotic resistance, and evaluate the efficacy of percutaneous aspiration.

Main Methods:

  • Retrospective review of 41 consecutive liver abscess cases from 1988 to 1994.
  • Analysis of etiological types, causative organisms, antibiotic sensitivities, and treatment outcomes.
  • Evaluation of percutaneous needle aspiration as a diagnostic and therapeutic tool.

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Main Results:

  • Pyogenic abscesses constituted 65% of cases, a shift from earlier studies where amoebic abscesses predominated.
  • Klebsiella pneumoniae was the most frequent pathogen in pyogenic liver abscesses.
  • Percutaneous needle aspiration was performed in 85% of pyogenic cases, with surgery required in only two instances due to complications.
  • Tuberculous abscesses were identified, highlighting the need for specific diagnostic measures.

Conclusions:

  • The etiology of liver abscesses in Singapore has shifted towards pyogenic forms, necessitating updated empirical antibiotic strategies.
  • Percutaneous aspiration is an effective method for diagnosis, culture yield, and management, potentially revealing other pathologies.
  • Routine cytological examination and acid-fast bacilli testing of aspirated material are recommended for comprehensive diagnosis.