Therapy of Liver Abscesses.
BACKGROUND
Liver abscess (LA) is an uncommon but potentially life-threatening disease with significant morbidity and mortality.


METHODS
This review comprehensively describes epidemiology, pathogenesis, diagnosis, and treatment of LA, with a strong focus on antimicrobial treatment choices and the impact of multidrug-resistant pathogens.


RESULTS
In industrialized areas, pyogenic liver abscess (PLA) accounts for over 80% of the cases, whereas Entamoeba histolyticais responsible for up to 10% of the cases, with a higher incidence in tropical areas. Highly virulent strains of Klebsiella pneumoniaehave emerged as a predominant cause of PLA in Asian countries and tend to spread to the USA, Australia, and European countries, therefore requiring special alertness. Most common symptoms of LA are fever, chills, and right upper quadrant abdominal pain, although a broad spectrum of non-specific symptoms may also occur.


CONCLUSIONS
Imaging studies (ultrasound, computed tomography scan) and microbiological findings play a crucial role in the diagnosis of LA. The treatment of choice for PLA is a multimodal approach combining broad-spectrum antibiotics and aspiration or drainage of larger abscess cavities. Amebic LA can be cured by metronidazole therapy without drainage.
Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
Christoph
C
Lübbert
Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
Johannes
J
Wiegand
Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
Thomas
T
Karlas
Amebic liver abscess; Antibiotics; Aspiration; Drainage; Entamoeba histolytica; Klebsiella pneumoniae; Liver abscess; Multidrug-resistant pathogens; Pyogenic liver abscess