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Prospective study of Streptococcus milleri hepatic abscess
J Corredoira1, E Casariego, C Moreno
1Department of Internal Medicine, Hospital Xeral-Calde, Lugo, Spain.
Abstract:
Thirty-seven cases of microbiologically demonstrated pyogenic hepatic abscess were observed in a prospective study over a seven-year period. Biliary disease was the most common source of liver abscess (42%). Streptococcus milleri was the most common cause of hepatic abscess, accounting for 51% of the cases. Hepatic abscess is due to Streptococcus milleri clinically distinct from other forms of pyogenic liver abscess due to its torpid nature and the longer duration of its symptoms [42 vs. 11 days]. Occult hepatic abscess should be suspected if the blood culture is positive for Streptococcus milleri, since 28% of bacteremia cases due to Streptococcus milleri stem from hepatic abscesses. It is important to distinguish Streptococcus milleri from other members of the viridans streptococci group, which are frequently isolated as contaminants, but only exceptionally cause hepatic abscess. Unlike other pyogenic hepatic abscesses, those caused by Streptococcus milleri are frequently monomicrobial (79%). In the present study, empirical therapy of pyogenic hepatic abscess always included a drug that is effective against Streptococcus milleri.
Insights
Pyogenic hepatic abscesses are often caused by Streptococcus milleri, leading to a slower, longer-lasting illness. Suspect occult liver abscess if Streptococcus milleri is found in blood cultures.
Area of Science:
- Hepatology
- Microbiology
- Infectious Diseases
Background:
- Pyogenic hepatic abscesses are serious infections requiring prompt diagnosis and treatment.
- Biliary disease is a common predisposing factor for liver abscesses.
- Streptococcus milleri is a significant pathogen in hepatic abscess formation.
Purpose of the Study:
- To investigate the characteristics and outcomes of pyogenic hepatic abscesses.
- To identify the common causative agents and sources of hepatic abscesses.
- To highlight the distinct clinical presentation of Streptococcus milleri-induced hepatic abscesses.
Main Methods:
- Prospective study over seven years.
- Microbiological demonstration of pyogenic hepatic abscesses.
- Analysis of clinical data, including symptoms, duration, and causative organisms.
Main Results:
- Thirty-seven cases of pyogenic hepatic abscess were identified.
- Biliary disease was the source in 42% of cases.
- Streptococcus milleri was the most common pathogen (51%), often causing monomicrobial abscesses (79%).
- Streptococcus milleri abscesses presented with a longer duration of symptoms (42 days vs. 11 days).
- Occult hepatic abscess should be considered in 28% of Streptococcus milleri bacteremia cases.
- Empirical therapy included agents effective against Streptococcus milleri.
Conclusions:
- Streptococcus milleri is a distinct cause of pyogenic hepatic abscess with a typically torpid clinical course.
- Early suspicion and targeted therapy are crucial for Streptococcus milleri hepatic abscesses.
- Differentiating Streptococcus milleri from other viridans streptococci is important due to its pathogenic potential.