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==Fournier's gangrene==
==Actinomycosis==


{| class="wikitable" style="border: 2; background: none;"
===Treatment===
! colspan="1" rowspan="2" style="border: 1; background: 1;"| Physiologic Variables
{| class="wikitable"
! colspan="4" rowspan="1"| High Abnormal Values
!Type
! colspan="1" rowspan="1"| Normal
!Treatment
! colspan="4" rowspan="1"| Low Abnormal Values
|- colspan="1" rowspan="2" style="border: 1; background: 1;"
! +4 || +3 || +2 || +1 || 0 || +1 || +2 || +3 || + 4
|-
|-
! rowspan="1" style="border: 1; background: none;"| Temperature
|Central Nervous system
| >41 || 39-40.0|| ||38.5-39 || 36-38.4 || 34-35.9 || 32-33.9 || 30-31.9 || <29.9
actinomycosis
|
|-
|-
! rowspan="1" style="border: 1; background: none;"| Heart Rate
|
| >180 || 140-179 || 110-139 || || 70-109 || || 55-69 || 40-54 || <39
|
|-
|-
! rowspan="1" style="border: 1; background: none;"| Respiratory Rate
|
| >50 || 35-49 || ||25-34||12-24||10-11||6-9|| || <5
|
|-
|}
! rowspan="1" style="border: 1; background: none;"| Serum Sodium (mmol/L)
 
| || || || || || || || ||  
==Amoebic liver abscess diagnosis==
|-
{{familytree/start}}
! rowspan="1" style="border: 1; background: none;"| Serum Potassium (mmol/L)
{{familytree | | | | | | | | | | | | A01 | | | | A01='''Diagnosis of amoebic liver abscess'''}}
| || || || || || || || ||  
{{familytree | | | | | | | | | | | | |!| | | | |}}
|-
{{familytree | | | | | | | | | | | | B01 | | | | B01='''Signs and symptoms'''(a)<br> Fever, abdominal pain, point tenderness over the liver, hepatomegaly, weight loss<br> '''History''' <br> Travel to endemic areas, immigrant from endemic areas, having had dysentery within last years, gender (male/female:9/1 }}
! rowspan="1" style="border: 1; background: none;"| Serum Creatinine<br>(mg/100/ml*2 for acute renal failure)
{{familytree | | | | | | | | | | | | |!| | | | |}}
| || || || || || || || ||  
{{familytree | | | | | | | | | | | | C01 | | | | C01= Laboratory diagnosis(LD) and Radiologic Methods (RM) (US, CT or MRI)}}
|-
{{familytree | | | | | | | | | | | | |!| | | | |}}
! rowspan="1" style="border: 1; background: none;"| Hematocrit
{{familytree | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| |}}
| || || || || || || || ||  
{{familytree | | | D01 | | | | | | | D02 | | | | | | |D03 | |D01=LD negative and RM negative:Floow|D02=LD negative and RM positive:aspiration, if possible(b)|D03=LD positive and RM positive: chemotherapy / surgical treatment}}
|-
{{familytree | | | | | | | | | | | | |!| | | | | | | | | |}}
! rowspan="1" style="border: 1; background: none;"| WBC (Total/mm*1000)
{{familytree | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| |}}
| || || || || || || || ||  
{{familytree | | | | | | E01 | | | | | | | | | | E02 |E01=Pyogenic abscesses <br> Neoplasia (hepatocellular carcinoma)<br>Cysticercosis<br>Cystic echinococcosis|E02=ALA}}
|-
{{familytree/end}}
! rowspan="1" style="border: 1; background: none;"| Serum Bicarbonate (Venous,mmol/l)
 
| || || || || || || || ||  
==Liver abscess==
{{familytree/start}}
{{familytree | | | | | | | | | | | | A01 | | | | A01='''Liver abscess'''}}
{{familytree | | | | | | | | | | | | |!| | | | |}}
{{familytree | | | | | | | | | | | | B01 | | | | B01='''Risk factors'''}}
{{familytree | | | |,|-|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|.|}}
{{familytree | | | C01 | | | | C02 | | | | C03 | | | | C04 |C01='''Hematogenous'''|C02='''Biliary'''|C03='''Underlying lesions or anamolies'''|C04='''Other causes'''}}
{{familytree | | | |!| | | | | |!| | | | | |!| | | | | |!|}}
{{familytree | | | D01 | | | | D02 | | | | D03 | | | | D04 | D01='''Portal vein'''<br>Intra-abdominal [[infection]]<br>Pyelophlebitis<br>[[Abdominal abscess]]<br>[[Amoebiasis]] <br> '''Arterial'''<br>[[ENT]]<br>[[Oral cavity]]|D02=[[Gall stones]]<br>Obstructed bile duct<br>Contiguous spread, [[ascending cholangitis]]<br>[[Bile duct]] [[ischemia]]|D03=Biliary cyst<br>[[Hydatid cyst]]<br>[[Cystadenoma]]<br>[[Necrosis]] of a [[primary tumor]]<br>[[Superinfection]] of a [[metastasis]]<br>[[Caroli disease]]<br>Biliary stricture<br>[[Sclerosing cholangitis]]<br>Ischemic cholangitis|D04=[[Radiofrequency ablation]] / [[Chemoembolization]] in the presence of infected [[bile]]<br>Pancreatoduodenectomy<br>[[Liver transplantation]]<br>Hepatic trauma ± arterial embolization}}
{{familytree/end}}
 
==Causes liver abscess==


|}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | A01='''Pyogenic liver abscess'''}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| |}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | B01 | | B01='''Causes'''}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|.|}}
{{familytree | | | | C01 | | | | | | | | | C02 | | | | | | | | C03 | | | | | | | | C04 | | | | | | | | C05 |C01='''Hepatobiliary'''|C02='''Portal'''|C03='''Arterial'''|C04='''Traumatic'''|C05='''Cryptogenic'''}}
{{familytree | | | | |!| | | | | | | | | | |!| | | | | | | | | |!| | | | | | | | | | |!| | | |}}
{{familytree | |,|-|-|^|-|-|.| | | | |,|-|-|^|-|-|.| | | | | | |!| | | | | | |,|-|-|-|^|-|-|-|.|}}
{{familytree | D01 | | | | D02 | | | D03 | | | | D04 | | | | | D05 | | | | | D06 | | | | | | D07 |D01=Benign|D02=Malignant|D03=Benign|D04=Malignant|D05= • Endocarditis<br> • Vascular sepsis<br> • Dental infection<br> • ENT infection|D06=Benign|D07=Malignant}}
{{familytree | |!| | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | | | |!| | | | | | | |!|}}
{{familytree | E01 | | | | E02 | | | E03 | | | | E04 | | | | | | | | | | | | E05 | | | | | | E06|E01= • Lithiasis<br> • Cholicystitis<br> • Biliary enteric anastomosis<br> • Percutaneous biliary procedures<br> • Endoscopic biliary procedures|E02= • Gall bladder<br> • Common bile duct<br> • Head of pancreas<br> • Ampulla|E03= • Appendicitis<br> • Diverticulitis<br> • Pelvic suppuration<br> • Anorectal suppuration<br> • Pancreatic abscess<br> • Postoperative sepsis<br> • Intestinal perforation<br> • Inflammatory bowel disease|E04= • Gastric cancer<br> • Colon cancer|E05= • Open or closed abdominal trauma|E06= • Percutaneous ethanol injection or radiofrequency<br> • Chemoembolization}}
{{familytree/end}}


==Treatment==
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= '''Treatment'''}}
{{Family tree | | | |,|-|-|^|-|-|.|}}
{{Family tree | | | B01 | | | | B01|B01=Non-surgical treatment|B02=Open surgical drainage}}
{{family tree | |,|-|^|-|.|}}
{{family tree | C01 | | C02|C01=Conservative management with antibiotics alone|C02=Open surgical drainage}}
{{Family tree/end}}


==Drainage==
{{Family tree/start}}
{{Family tree | | | | | | | A01 | | | |A01= '''Drainage'''}}
{{Family tree | | | |,|-|-|-|+|-|-|-|.|}}
{{Family tree | | | B01 | | B02 | | B03|B01=Percutaneous drainage|B02=Open surgical drainage|B03=Endoscopic retrograde cholangiopancreatography (ERCP)}}
{{family tree | |,|-|^|-|.|}}
{{family tree | C01 | | C01 |C01=CT guided|C02=Ultrasound guided}}
{{Family tree/end}}


{| class="wikitable" style="text-align:center"
|-
! Region !! Gender !! Incidence/100,000 !! Prevalence/100,000
|-
! rowspan="2" | Region 1
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 2
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 3
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 4
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 5
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|}


==Zika Prevention==
The mainstay of therapy for pyogenic liver abscesses is [[percutaneous]] drainage and antimicrobial therapy.  Empiric therapy for pyogenic [[liver]] [[abscesses]] consists of either a second- or third-generation [[cephalosporin]] with [[metronidazole]] or [[piperacillin-tazobactam]]. [[Amoebiasis|Amebic liver abscesses]] are often treated medically with a short course of [[metronidazole]] or [[tinidazole]] followed by 20 days of [[iodoquinol]].


{|
==Medical Therapy==
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''How Long to Wait Before Attempting to Have a Baby in Zika Endemic areas'''}}
*It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on [[serology]], culture results, and response to therapy.<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref>
|-
*The mainstay of therapy for pyogenic hepatic abscesses is [[ultrasound]]/CT-guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous [[antibiotics]].<ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue= | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221  }} </ref>
! style="width: 180px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Presence of Symptoms}}
*Empiric [[antibiotics]] should only be used initially, with [[diagnostic]] aspiration and culture performed as soon as possible.
! style="width: 250px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Women}}
*Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:<ref name="pmid12660071">{{cite journal| author=Stanley SL| title=Amoebiasis. | journal=Lancet | year= 2003 | volume= 361 | issue= 9362 | pages= 1025-34 | pmid=12660071 | doi=10.1016/S0140-6736(03)12830-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12660071  }} </ref>
! style="width: 250px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Men}}
:*Severe clinical illness
|-
:*Uncertain diagnosis
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''Zika symptoms'''
:*No response to [[metronidazole]] therapy (after 4 days of treatment)
| style="background: #DCDCDC; padding: 5px;" | At least 8 weeks after symptoms start
:*Large left-lobe abscesses (risk of rupture into [[pericardium]])
| style="background: #DCDCDC; padding: 5px;" | At least 6 months after symptoms start
:*Imminent rupture
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''No Zika symptoms'''
| style="background: #DCDCDC; padding: 5px;" | Talk with doctor or healthcare provider
| style="background: #DCDCDC; padding: 5px;" | Talk with doctor or healthcare provider
|}


==Zika sexual transmission==
===Antibiotic Regimens===
{|
* '''Pyogenic Liver Abscess'''
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For People Who Have Traveled to an Area with Zika'''}}
:* '''1. Empiric antimicrobial therapy'''<ref name="pmid15578367">{{cite journal| author=Rahimian J, Wilson T, Oram V, Holzman RS| title=Pyogenic liver abscess: recent trends in etiology and mortality. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 11 | pages= 1654-9 | pmid=15578367 | doi=10.1086/425616 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15578367  }} </ref><ref name="pmid15667489">{{cite journal| author=Lederman ER, Crum NF| title=Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 2 | pages= 322-31 | pmid=15667489 | doi=10.1111/j.1572-0241.2005.40310.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667489  }} </ref><ref name="pmid26287275">{{cite journal| author=Lübbert C, Wiegand J, Karlas T| title=Therapy of Liver Abscesses. | journal=Viszeralmedizin | year= 2014 | volume= 30 | issue= 5 | pages= 334-41 | pmid=26287275 | doi=10.1159/000366579 | pmc=PMC4513824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26287275  }} </ref><ref name="pmid15245694">{{cite journal| author=Kurland JE, Brann OS| title=Pyogenic and amebic liver abscesses. | journal=Curr Gastroenterol Rep | year= 2004 | volume= 6 | issue= 4 | pages= 273-9 | pmid=15245694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245694  }} </ref><ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue=  | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221  }} </ref>
|-
::* Preferred regimen (1): ([[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you are pregnant'''
::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
| style="background: #DCDCDC; padding: 5px;" | Pregnant women should not travel to areas with Zika. If you must travel to an area with Zika, talk to your healthcare provider.
::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
|-
::* Note: The empiric therapy for pyogenic abscesses should be based on local resistance patterns, with particular attention to resistant Klebsiella spp.. Ampicillin is not recommended due to the high resistance found among Klebsiella spp.. There is no set duration for treatment, which may vary from 2 to 6 weeks.
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If your partner is pregnant'''
:* '''2. Pathogen-directed antimicrobial therapy'''
| style="background: #DCDCDC; padding: 5px;" | Use condoms correctly, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy.
::* '''2.1 Klebsiella spp.'''<ref name="pmid15667489">{{cite journal| author=Lederman ER, Crum NF| title=Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 2 | pages= 322-31 | pmid=15667489 | doi=10.1111/j.1572-0241.2005.40310.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667489  }} </ref>
|-
:::* Preferred regimen: [[Gentamicin]] {{and}} ([[Piperacillin-Tazobactam]] 3.375 g IV q6h {{or}} [[Cefazolin]] 0.5-1 g IV q6-8h {{or}} [[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) for 2–3 wk 
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you and your partner are planning a pregnancy'''
:::*Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or second/third-generation cephalosporin).
| style="background: #DCDCDC; padding: 5px;" | Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.  
* '''Amebic Liver Abscess'''
|-
:* Preferred regimen (1): [[Metronidazole]] 2-4 g PO qd for 2 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are not pregnant and are not planning a pregnancy'''
:* Preferred regimen (2): [[Tinidazole]] 2 g PO qd for 3 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days
| style="background: #DCDCDC; padding: 5px;" | Men - consider using condoms or not having sex for at least 6 months after travel (if you don’t have symptoms) or for at least 6 months from the start of symptoms (or Zika diagnosis) if you develop Zika.<br> Women- consider using condoms or not having sex for at least 8 weeks after travel (if you don’t have symptoms) or for at least 8 weeks from the start of symptoms (or Zika diagnosis) if you develop Zika.
|}


{|
==References==
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For People Living in an Area with Zika'''}}
{{reflist|2}}
|-
{{WH}}
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are pregnant'''
{{WS}}
| style="background: #DCDCDC; padding: 5px;" | Use condoms from start to finish, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy.<br> It is also very important to see a healthcare provider to discuss your options during pregnancy
[[Category:Gastroenterology]]
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you and your partner are planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are not pregnant and are not planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Consider using condoms or not having sex as long as there is Zika in the area.  If either you or your partner develop symptoms of Zika or have concerns, talk to a healthcare provider and follow the guidelines on the left.
|}


==Hand foot and mouth disease==
[[Category:Mature chapter]]
{| style="font-size: 85%;"
[[Category:Disease]]
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Viruses}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Serotypes}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Coxsackieviruses '''
| style="background: #DCDCDC; padding: 5px;" | A2, A4 to A10, '''A16''', B2, B3, B5
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Echoviruses'''
| style="background: #DCDCDC; padding: 5px;" | 1, 4, 7, 19
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Enteroviruses'''
| style="background: #DCDCDC; padding: 5px;" | '''A71'''
|}

Latest revision as of 18:43, 18 September 2017

Actinomycosis

Treatment

Type Treatment
Central Nervous system

actinomycosis

Amoebic liver abscess diagnosis

 
 
 
 
 
 
 
 
 
 
 
Diagnosis of amoebic liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signs and symptoms(a)
Fever, abdominal pain, point tenderness over the liver, hepatomegaly, weight loss
History
Travel to endemic areas, immigrant from endemic areas, having had dysentery within last years, gender (male/female:9/1
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Laboratory diagnosis(LD) and Radiologic Methods (RM) (US, CT or MRI)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LD negative and RM negative:Floow
 
 
 
 
 
 
LD negative and RM positive:aspiration, if possible(b)
 
 
 
 
 
 
LD positive and RM positive: chemotherapy / surgical treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyogenic abscesses
Neoplasia (hepatocellular carcinoma)
Cysticercosis
Cystic echinococcosis
 
 
 
 
 
 
 
 
 
ALA

Liver abscess

 
 
 
 
 
 
 
 
 
 
 
Liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk factors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematogenous
 
 
 
Biliary
 
 
 
Underlying lesions or anamolies
 
 
 
Other causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal vein
Intra-abdominal infection
Pyelophlebitis
Abdominal abscess
Amoebiasis
Arterial
ENT
Oral cavity
 
 
 
Gall stones
Obstructed bile duct
Contiguous spread, ascending cholangitis
Bile duct ischemia
 
 
 
Biliary cyst
Hydatid cyst
Cystadenoma
Necrosis of a primary tumor
Superinfection of a metastasis
Caroli disease
Biliary stricture
Sclerosing cholangitis
Ischemic cholangitis
 
 
 
Radiofrequency ablation / Chemoembolization in the presence of infected bile
Pancreatoduodenectomy
Liver transplantation
Hepatic trauma ± arterial embolization

Causes liver abscess

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyogenic liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatobiliary
 
 
 
 
 
 
 
 
Portal
 
 
 
 
 
 
 
Arterial
 
 
 
 
 
 
 
Traumatic
 
 
 
 
 
 
 
Cryptogenic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benign
 
 
 
Malignant
 
 
Benign
 
 
 
Malignant
 
 
 
 
• Endocarditis
• Vascular sepsis
• Dental infection
• ENT infection
 
 
 
 
Benign
 
 
 
 
 
Malignant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Lithiasis
• Cholicystitis
• Biliary enteric anastomosis
• Percutaneous biliary procedures
• Endoscopic biliary procedures
 
 
 
• Gall bladder
• Common bile duct
• Head of pancreas
• Ampulla
 
 
• Appendicitis
• Diverticulitis
• Pelvic suppuration
• Anorectal suppuration
• Pancreatic abscess
• Postoperative sepsis
• Intestinal perforation
• Inflammatory bowel disease
 
 
 
• Gastric cancer
• Colon cancer
 
 
 
 
 
 
 
 
 
 
 
• Open or closed abdominal trauma
 
 
 
 
 
• Percutaneous ethanol injection or radiofrequency
• Chemoembolization

Treatment

 
 
 
 
 
Treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-surgical treatment
 
 
 
Non-surgical treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative management with antibiotics alone
 
Open surgical drainage

Drainage

 
 
 
 
 
 
Drainage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percutaneous drainage
 
Open surgical drainage
 
Endoscopic retrograde cholangiopancreatography (ERCP)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CT guided
 
CT guided


The mainstay of therapy for pyogenic liver abscesses is percutaneous drainage and antimicrobial therapy. Empiric therapy for pyogenic liver abscesses consists of either a second- or third-generation cephalosporin with metronidazole or piperacillin-tazobactam. Amebic liver abscesses are often treated medically with a short course of metronidazole or tinidazole followed by 20 days of iodoquinol.

Medical Therapy

  • It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on serology, culture results, and response to therapy.[1]
  • The mainstay of therapy for pyogenic hepatic abscesses is ultrasound/CT-guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous antibiotics.[2]
  • Empiric antibiotics should only be used initially, with diagnostic aspiration and culture performed as soon as possible.
  • Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:[3]
  • Severe clinical illness
  • Uncertain diagnosis
  • No response to metronidazole therapy (after 4 days of treatment)
  • Large left-lobe abscesses (risk of rupture into pericardium)
  • Imminent rupture

Antibiotic Regimens

  • Pyogenic Liver Abscess
  • Preferred regimen (1): (Ceftriaxone 1-2 g IV/IM q24h OR Cefotaxime 1-2 g IV or IM q8h) AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
  • Preferred regimen (2): Ciprofloxacin 400 mg IV q12h AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q6h
  • Note: The empiric therapy for pyogenic abscesses should be based on local resistance patterns, with particular attention to resistant Klebsiella spp.. Ampicillin is not recommended due to the high resistance found among Klebsiella spp.. There is no set duration for treatment, which may vary from 2 to 6 weeks.
  • 2. Pathogen-directed antimicrobial therapy
  • 2.1 Klebsiella spp.[5]
  • Amebic Liver Abscess

References

  1. Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
  2. 2.0 2.1 Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O; et al. (2011). "Modern management of pyogenic hepatic abscess: a case series and review of the literature". BMC Res Notes. 4: 80. doi:10.1186/1756-0500-4-80. PMC 3073909. PMID 21435221.
  3. Stanley SL (2003). "Amoebiasis". Lancet. 361 (9362): 1025–34. doi:10.1016/S0140-6736(03)12830-9. PMID 12660071.
  4. Rahimian J, Wilson T, Oram V, Holzman RS (2004). "Pyogenic liver abscess: recent trends in etiology and mortality". Clin Infect Dis. 39 (11): 1654–9. doi:10.1086/425616. PMID 15578367.
  5. 5.0 5.1 Lederman ER, Crum NF (2005). "Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics". Am J Gastroenterol. 100 (2): 322–31. doi:10.1111/j.1572-0241.2005.40310.x. PMID 15667489.
  6. Lübbert C, Wiegand J, Karlas T (2014). "Therapy of Liver Abscesses". Viszeralmedizin. 30 (5): 334–41. doi:10.1159/000366579. PMC 4513824. PMID 26287275.
  7. Kurland JE, Brann OS (2004). "Pyogenic and amebic liver abscesses". Curr Gastroenterol Rep. 6 (4): 273–9. PMID 15245694.

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