Invasive liver abscess syndrome caused by Klebsiella pneumoniae
- Wen-Liang Yu, MD
Wen-Liang Yu, MD
- Associate Professor of Medicine
- Chi-Mei Medical Center, Taiwan
- Yin-Ching Chuang, MD
Yin-Ching Chuang, MD
- Professor of Medicine
- Chi-Mei Medical Center, Taiwan
Klebsiella pneumoniae can produce infection at a variety of sites, with the risk being increased in patients with impaired host defenses (eg, diabetes mellitus, alcoholism, malignancy, chronic obstructive pulmonary disease, and glucocorticoid therapy). K. pneumoniae is also associated with a community-acquired primary invasive liver abscess syndrome. In addition to liver abscess, some patients develop metastatic infection at other sites.
Issues related to the K. pneumoniae invasive liver abscess syndrome will be reviewed here. The epidemiology, clinical features (including the general principles of diagnosis and treatment), microbiology, and pathogenesis of K. pneumoniae infection are discussed separately. (See "Clinical features, diagnosis, and treatment of Klebsiella pneumoniae infection" and "Microbiology and pathogenesis of Klebsiella pneumoniae infection".)
K. pneumoniae primary liver abscess has been variably defined in the literature. In one study, for example, primary liver abscess was defined as a K. pneumoniae liver abscess occurring in the absence of predisposing intraabdominal factors, such as hepatobiliary disease, colorectal disease, or a history of intraabdominal surgery or trauma . In other studies, it has been defined by a monomicrobial K. pneumoniae isolate, while polymicrobial liver abscess was usually secondary to hepatobiliary disease or intraabdominal infection [2,3].
We prefer to define K. pneumoniae primary liver abscess (KLA) as liver abscess that occurs in the absence of hepatobiliary disease. Almost all of these infections are monomicrobial [3-5]. Although this topic highlights virulent strains of K. pneumoniae that have the capacity to invade a healthy liver without predisposing anatomical abnormalities, the rare possibility of concurrent colorectal disease cannot be excluded, as routine colonoscopy is not generally performed in the setting of KLA. (See "Pyogenic liver abscess", section on 'Association with colorectal neoplasia'.)
Most cases of K. pneumoniae primary liver abscess (KLA), particularly those associated with metastatic infection, have been reported in Taiwan and are community-acquired [1-12]. In a series of 248 patients with pyogenic liver abscess from Taiwan, for example, K. pneumoniae was responsible for 171 (69 percent) .
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- PATHOGENESIS AND RISK FACTORS
- Host factors
- - Diabetes mellitus
- - Other host factors
- Virulence factors
- Antibiotic use
- Risk factors for metastatic disease
- CLINICAL MANIFESTATIONS
- Metastatic infection
- DIFFERENTIAL DIAGNOSIS
- Antibiotic choice
- Duration of therapy
- Treatment of metastatic infection