Liver Abscess
Chapter 351 Liver Abscess
Pyogenic liver abscesses are rare in children, with an incidence of 10/100,000 hospitalizations. Pyogenic hepatic abscesses can be caused by bacteria entering the liver via the portal circulation in cases of omphalitis, portal vein pylephlebitis, intra-abdominal infection, or abscess secondary to appendicitis or inflammatory bowel disease; a primary bacteremia (sepsis, endocarditis); ascending cholangitis associated with biliary tract obstruction caused by gallstones or sclerosing cholangitis, after a Kasai procedure, or secondary to choledochal cysts; contiguous infection or penetrating trauma; and cryptogenic biliary tract infections. Very rarely, liver abscesses occur after percutaneous liver biopsy. Hepatic abscesses can also occur in neonates in association with sepsis, umbilical vein infection, or cannulation; 50% are seen in children < 6 yr old. In adults with pyogenic liver abscesses, liver transplantation is a significant risk factor; it is not known if pediatric liver transplant patients are also at increased risk. Children with chronic granulomatous disease, Job syndrome or cancer are also at increased risk for a hepatic abscess.
In children with pyogenic liver abscesses, the most common pathogenic organisms include Staphylococcus aureus, Streptococcus spp; Escherichia coli, Klebsiella pneumoniae, Salmonella, and anaerobic organisms; Entamoeba histolytica or Toxocara canis–associated liver abscesses have also been reported in developing countries or in highly endemic areas.
Amebic disease is rare in the USA and is associated with immigrants from or travel to highly endemic areas. Recovery of E. histolytica from the stool is pathogenic and highly suggestive of an amebic abscess, but this must be distinguished from E. dispar, which looks similar but is nonpathogenic; antiamebic antibodies help identify E. histolyticum. Multiple microabscesses are most commonly secondary to bacteremia, candidemia, or cat scratch disease. Polymicrobial involvement is seen in ~50%; cryptogenic abscesses are often monomicrobial with S. aureus as the lead single agent in children.
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