title: Presentations of pyogenic liver abscess in one UK centre over a 15-year period.
abstract: OBJECTIVE
  Pyogenic liver abscess (PLA) has been a condition of high mortality, improving over recent decades with combined antibiotic and percutaneous drainage. We aimed to identify the presenting features, diagnosis, microbiology, treatment and outcome for patients over a 15-year period at an inner-city hospital.
  
  
  METHODS
  Patients with an appropriate discharge diagnosis were identified and case records retrospectively analysed.
  
  
  RESULTS
  A total of 73 patient records were analysed. Common presenting features were anorexia, abdominal pain, fever, vomiting and weight loss with raised white cell count, C-reactive protein, alkaline phosphatase and hypoalbuminaemia. The delay following symptom onset to presentation was a mean of 17.3 days. The inclusion of PLA as a possible diagnosis on admission was only considered in 1% of cases. Positive blood or abscess culture was achieved in 63% of cases. We recorded a hospital mortality rate of 11%.
  
  
  CONCLUSIONS
  In this sample, PLA was rarely considered as a possible diagnosis at presentation. There are common presenting features, which should prompt early investigation. Our microbiological yield was lower than in some studies and may be due to the early empirical use of antibiotics, without microbiological guidance. Percutaneous drainage and antibiotic treatment remain the mainstay of management. The underlying cause for PLA is often not identified. Emerging septicaemia or underlying malignancy were strong predictors of mortality.
authors.affiliation: Sandwell and West Birmingham NHS Trust, Birmingham, UK. nickbosanko@doctors.net.uk
authors.forename: N C
authors.initials: NC
authors.lastname: Bosanko
authors.forename: A
authors.initials: A
authors.lastname: Chauhan
authors.forename: M
authors.initials: M
authors.lastname: Brookes
authors.forename: M
authors.initials: M
authors.lastname: Moss
authors.forename: P G
authors.initials: PG
authors.lastname: Wilson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000855:Anorexia / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D034141:Hypoalbuminemia; D007958:Leukocyte Count; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein; D000469:Alkaline Phosphatase