CONTINUING CHANGING PATTERNS OF DISEASE IN PYOGENIC LIVER-ABSCESS - A STUDY OF 38 PATIENTS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 79  (3) , 217-226
Abstract
Changes in the etiology, clinical features, methods of diagnosis and treatment of pyogenic liver abscess have occurred slowly but continuously over the past century. The earlier changes are well documented in the literature, and continuing variations in the classic patterns of disease are now evident. These include a recent increase in incidence reflecting more accurate diagnostic techniques; changes in bacteriology with a high incidence of Klebsiella infection; a reduction in mortality, reflecting earlier diagnosis and more refined therapeutic methods; and changes in the population at risk namely a large population of terminal cancer patients. A total of 38 patients treated over the past 16 yr, 1967-1982, were divided into 2 groups, each of 8 yr duration, reflecting an earlier era before routine use of scanning procedures, and a later period when Tc, Ga, sonographic and more recently CT [computed tomographic] imaging procedures were regularly done. During the latter period there was a significant increase in both the total number of liver abscesses diagnosed and in the number estimated as a proportion of all hospital admissions. Mortality has continued to fall to more acceptable levels with a 25% reduction overall. In the early era, extrahepatic intraabdominal infection caused all 4 deaths. In the past 8 yr obstructing or metastatic cancer has caused 4 of the 5 deaths. Bacteremia occurred in 6 of the 9 deaths, 5 of these being of biliary origin. The decrease in mortality may reflect earlier diagnosis, an increase in the number of solitary abscesses and better therapy.