Table 2.
This table illustrates differences among bacterial, amebic and Aspergillus liver abscesses
| Bacterial | Amebic | Aspergillus | |
|---|---|---|---|
| Age | Older age | Middle age | Younger age |
| Gender | Male predominant | Male predominant (7–10 times more common in adult men) | Male predominant |
| Main risk factors |
• Older age • Diabetes • Malnutrition |
• Poor sanitation • Travel to endemic area • Oral and anal sex • Alcohol use |
• Immunosuppression • Malignancy especially hematological e.g., ALL, AML • Organ transplant/bone marrow transplant |
| Most common pathogens | Escherichia coli, Klebsiella spp, Streptococcus anginosus group, Staphylococcus aureus, and anaerobes | Entamoeba histolytica | Aspergillus spp |
| Initial source of infection |
• Biliary disease (50–60%) • Cryptogenic (35%) |
Infection with E. histolytica cyst via fecal-oral transmission |
• Cryptogenic (43%) • Primary lung infection with hematogenous spread (28%) • Intra-abdominal GI infection (19%) |
|
Clinical manifestations |
• Fever • Abdominal pain • Constitutional symptoms • Jaundice • Septic emboli to eye, brain, meninges seen in Klebsiella BLA |
• Fever • Abdominal pain • Constitutional symptoms • Concurrent diarrhea in < 1/3 of cases • Jaundice |
• Fever • Abdominal pain • Constitutional symptoms • Coinfection with other pathogens (33%) |
| Laboratory findings |
• Leucocytosis common • LFTs derangement common • Increase in inflammatory markers (CRP, ESR) • In 30% blood cultures negative |
• E. histolytica serology is useful to distinguish amoebic from BLA in non endemic regions • Serology can be negative in the 1st week of infection |
• Galactomannan positive 57% • Blood cultures positive 11% |
|
Imaging characteristics |
• Usually, multiple lesions in the right lobe of the liver • Abscess size < 10 mm in diameter • Septations are common • Gas within abscess: suspect Klebsiella spp |
• Typically, solitary lesion • Subcapsular • Abscess size 5–10 cm (depends on the ALA form – chronic indolent abscesses are larger) • Most common location: the posterior part of the right lobe (70–80%) |
• Solitary abscess (52%) • Multiple abscesses (48%) • Abscess size 2.2–9 cm |
| Mortality |
• Mortality 2.5–19% • Highest mortality in biliary origin compared to other causes • Higher risk of spontaneous rupture in Klebsiella BLA |
• Mortality 1–3% • Excellent prognosis as they are very sensitive to antimicrobial medical therapy |
• Mortality 38% |