Liver Abscess: Diagnostic and Management Issues Found in the Low Resource Setting

Overview

Journal Br Med Bull

Publisher Oxford University Press

Specialty General Medicine

Date 2019 Dec 15

PMID 31836890

Citations 53

Authors

Gaetan Khim

Sokhom Em

Satdin Mo

Nicola Townell

Affiliations

Soon will be listed here.

Abstract

Introduction: Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings.

Sources Of Data: We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'.

Areas Of Agreement: Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics.

Areas Of Controversy: In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings.

Growing Points: As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced.

Areas Timely For Developing Research: The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.

Citing Articles

Amoebic liver abscess: diagnosis and management of a single case in Guangdong, China.

He Y, Huang D, Yang Y BMC Infect Dis. 2025; 25(1):350.

PMID: 40075356 PMC: 11905540. DOI: 10.1186/s12879-025-10623-0.

Clinical Outcomes of Liver Abscesses in Adults: A 10-Year Experience at a Tertiary Care Center in Northern India.

Gupta A, Thakur N, Chaudhary A, Patel U, Arti Cureus. 2025; 16(12):e75454.

PMID: 39803050 PMC: 11725050. DOI: 10.7759/cureus.75454.

A rare case of amebic liver abscess with spontaneous hepatico-cholecystic as well as cholecysto-duodenal fistula.

Sahdev R, Chandra A, Prakash S, Manrai M, Srivastava S, Dawra S Med J Armed Forces India. 2024; 80(Suppl 1):S427-S429.

PMID: 39734886 PMC: 11670690. DOI: 10.1016/j.mjafi.2024.02.001.

Computed Tomographic Findings in Dogs with Hepatic Bacterial Parenchymal Infection and Abscessation.

Mate de Haro L, Vila A, Di Bella A, Mallol C, Anselmi C, Barreiro-Vazquez J Animals (Basel). 2024; 14(23).

PMID: 39682365 PMC: 11640172. DOI: 10.3390/ani14233399.

Oral bacteria-associated liver abscess in conjunction with pulmonary arteriovenous fistula: a case report.

Liu J, Meng X, Wang J, Wu K, Xiao Y, Hong Z World J Emerg Med. 2024; 15(6):511-513.

PMID: 39600818 PMC: 11586148. DOI: 10.5847/wjem.j.1920-8642.2024.058.

References

Candler W, Phuphaisan S, Echeverria P, Liangthorachon B, BHAIBULAYA M, Arthur J . Amebiasis at an evacuation site on the Thai-Cambodian border. Southeast Asian J Trop Med Public Health. 1990; 21(4):574-9. View

Om C, Daily F, Vlieghe E, McLaughlin J, McLaws M . inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control. 2016; 5:58. PMC: 5170903. DOI: 10.1186/s13756-016-0159-7. View

Seeto R, Rockey D . Amebic liver abscess: epidemiology, clinical features, and outcome. West J Med. 1999; 170(2):104-9. PMC: 1305450. View

Herbinger K, Fleischmann E, Weber C, Perona P, Loscher T, Bretzel G . Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection. 2011; 39(6):527-35. DOI: 10.1007/s15010-011-0155-z. View

Eykyn S, Phillips I . Microbiology of pyogenic liver abscess. Br Med J (Clin Res Ed). 1981; 283(6295):819-21. PMC: 1507072. DOI: 10.1136/bmj.283.6295.819. View

Miller R, Goodman C . Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review. Health Policy Plan. 2016; 31(7):940-953. PMC: 4977427. DOI: 10.1093/heapol/czw007. View

Maude R, Vatcharapreechasakul T, Ariyaprasert P, Maude R, Hongsuwan M, Yuentrakul P . Prospective observational study of the frequency and features of intra-abdominal abscesses in patients with melioidosis in northeast Thailand. Trans R Soc Trop Med Hyg. 2012; 106(10):629-31. PMC: 3449236. DOI: 10.1016/j.trstmh.2012.05.007. View

Minh P, Huong D, Byrkit R, Murray M . Strengthening pharmacy practice in vietnam: findings of a training intervention study. Trop Med Int Health. 2013; 18(4):426-34. DOI: 10.1111/tmi.12062. View

Ko W, Paterson D, Sagnimeni A, Hansen D, von Gottberg A, Mohapatra S . Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis. 2002; 8(2):160-6. PMC: 2732457. DOI: 10.3201/eid0802.010025. View

10.

Lee H, Lee H, Guo H, Ko W, Chen K . Clinical significance and mechanism of gas formation of pyogenic liver abscess due to Klebsiella pneumoniae. J Clin Microbiol. 2004; 42(6):2783-5. PMC: 427832. DOI: 10.1128/JCM.42.6.2783-2785.2004. View

11.

Stenson B, Syhakhang L, Lundborg C, Eriksson B, Tomson G . Private pharmacy practice and regulation. A randomized trial in Lao P.D.R. Int J Technol Assess Health Care. 2002; 17(4):579-89. View

12.

Chung D, Lee S, Lee H, Kim H, Choi H, Eom J . Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect. 2006; 54(6):578-83. DOI: 10.1016/j.jinf.2006.11.008. View

13.

Ch Yu S, Hg Lo R, KAN P, Metreweli C . Pyogenic liver abscess: treatment with needle aspiration. Clin Radiol. 1997; 52(12):912-6. DOI: 10.1016/s0009-9260(97)80223-1. View

14.

Kaplan G, Gregson D, Laupland K . Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol. 2004; 2(11):1032-8. DOI: 10.1016/s1542-3565(04)00459-8. View

15.

Tsutsumi V, Mena-Lopez R, Anaya-Velazquez F, Martinez-Palomo A . Cellular bases of experimental amebic liver abscess formation. Am J Pathol. 1984; 117(1):81-91. PMC: 1900566. View

16.

Saidin S, Yunus M, Zakaria N, Razak K, Huat L, Othman N . Production of recombinant Entamoeba histolytica pyruvate phosphate dikinase and its application in a lateral flow dipstick test for amoebic liver abscess. BMC Infect Dis. 2014; 14:182. PMC: 3986461. DOI: 10.1186/1471-2334-14-182. View

17.

Rajak C, Gupta S, Jain S, Chawla Y, Gulati M, Suri S . Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. 1998; 170(4):1035-9. DOI: 10.2214/ajr.170.4.9530055. View

18.

Bachler P, Baladron M, Menias C, Beddings I, Loch R, Zalaquett E . Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. Radiographics. 2016; 36(4):1001-23. DOI: 10.1148/rg.2016150196. View

19.

Su Y, Lai Y, Lin Y, Yeh Y . Treatment and prognosis of pyogenic liver abscess. Int J Emerg Med. 2011; 3(4):381-4. PMC: 3047832. DOI: 10.1007/s12245-010-0232-6. View

20.

Smith F . Private local pharmacies in low- and middle-income countries: a review of interventions to enhance their role in public health. Trop Med Int Health. 2009; 14(3):362-72. DOI: 10.1111/j.1365-3156.2009.02232.x. View