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Splenic abscess: another look at an old disease
G S Phillips1, M D Radosevich, P A Lipsett
1Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md 21287-4605, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|December 24, 1997
Summary
Splenic abscesses are increasingly common, with intravenous drug abuse and human immunodeficiency virus disease as significant risk factors. Broad-spectrum antimicrobial agents are recommended for treatment due to polymicrobial infections.
Area of Science:
- Infectious Diseases
- Abdominal Surgery
- Radiology
Background:
- Splenic abscesses are uncommon but serious infections.
- Understanding trends in incidence, causes, and management is crucial.
Purpose of the Study:
- To investigate changes in splenic abscess incidence, causes, bacteriologic profile, and management.
- To identify evolving risk factors and optimal treatment strategies.
Main Methods:
- Retrospective case study at a tertiary university referral center.
- Analysis of 39 patients with splenic abscesses.
- Review of demographics, clinical presentation, diagnostic methods, and outcomes.
Main Results:
- Fever and abdominal pain were common presenting symptoms.
- Metastatic infection and immunosuppression (including human immunodeficiency virus disease and intravenous drug use) were primary causes.
- Computed tomography (CT) demonstrated abscesses in all evaluated patients.
- Polymicrobial infections were frequent, with varying proportions of gram-positive, gram-negative, fungal, and mycobacterial isolates.
- Risk factors and bacteriologic profiles differed between pre- and post-1989 cohorts.
- Splenectomy, medical therapy, and percutaneous drainage showed varying survival rates, with percutaneous drainage achieving 100% survival.
Conclusions:
- Splenic abscesses are becoming more prevalent, with increasing association with intravenous drug abuse and human immunodeficiency virus disease.
- Diagnosis should be considered in patients with fever and abdominal pain, particularly those with risk factors.
- Empirical antimicrobial therapy should be broad-spectrum, covering polymicrobial infections and gram-positive organisms.