中台灣某醫學中心兒童肝膿瘍病例
分析
Pyogenic Liver Abscess among Children at a Medical Center in Central Taiwan
Yu-Lung Hsu, Hsiao-Chuan Lin, Ting-Yu Yen, Tsung-Hsueh Hsieh, Hsiu-Mei Wei, Kao-Pin Hwang
許玉龍、林曉娟、顏廷聿、謝宗學、衛琇玫、黃高彬
Division of Pediatric Infectious Diseases, Department ofPediatrics, China Medical University Hospital
中國醫藥大學附設醫院兒童醫學中心兒童感染科
2013.04.27Introduction
• Liver abscess in the pediatric population has
become relatively uncommon in developed
countries but still have high incidence in
developing countries.
• The majority (80%) of pediatric hepatic
abscesses refers to pyogenic liver abscess,
followed by amebic liver abscess.
Introduction
• Staphylococcus aureus is the commonest
isolated pathogen of pediatric PLA both in
developed and developing countries.
• However, K. pneumoniae was recognized as
the most frequent cause of pyogenic liver
abscess in Taiwan, both in adults and children.
• Emerg Infect Dis. 2008 Oct;14(10):1592-600 • World J Pediatr. 2010 Aug;6(3):210-6
Incidence
1 in 138 admissions in Brazil
Arq Gastroenterol 1997;34:49-54
78.9 per 100,000
admissions in south Indian
J Pediatr Surg 1998;33:417-21
25 per 100,000 admission in the USA
Am J Dis Child 1989;143:1424-7
Incidence
8.9 per 100,000 pediatric admissions
Acta Paediatr Taiwan 2003;44:282-6
20 per 100,000 pediatric admissions
J Formos Med Assoc 1994;93:45-50
Materials and Methods
• Period– from 1995 to 2011
• China Medical University Hospital • Age ≦18-year-old
• Satisfied at least one of the following criteria
– Demonstration of intrahepatic hypoechoic or anechoic lesions be imaging with simultaneous positive pus or blood culture, and these lesions were cured after antibiotics therapy;
– Percutaneous aspiration of purulent material from an intrahepatic lesion
– Liver abscess proven in operation. Acta Paediatr Taiwan 2003;44:282-6
• Liver abscess due to the complication of oncological
0 1 2 3 4 5
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Basic Data
Basic Data (n=15)
Age
13.53 ; 15 ; 5-18
Age≧10 y/o
13/15 (86.7%)
Gender (Male : Female)
6:9
Referred
9
Associated Condition
Association Condition
Number
Acute Appendicitis
2
Type 2 DM
2
Small intestine perforation
1
Thalassemia s/p splenectomy
1*
Type 1 DM
1
Clinical and Investigative Findings
Clinical presentations n=15
Fever 14 (93.3%)
Prolonged fever 7 (46.7%)
Abdominal pain 13 (86.7 %)
Right upper abdominal pain 5 (33.3%)
Cough 5 (33.3%)
Diarrhea 4 (26.7%)
Vomiting 2 (13.3%)
Clinical and Investigative Findings
Laboratory findings WBC (n=15) 16353.3 ± 5305.5 /ul WBC ≧ 15,000/ul 9/15 (60%) CRP (n=15) 19.2 ± 11.7 mg/dL CRP ≧ 10 mg/dL 12/15 (80%) GPT (n=12) 56.7 ± 35.2 IU/L GPT ≧ 40 IU/L 6/12 (50%) GOT (n=11) 43.0 ± 26.4 IU/L Culture findings Blood culture (n=15) 3/15 (20 %) Pus culture (n=14) 12/14 (85.7 %)Image Findings
Image Findings (n=15)
Single abscess 13/15 (86.7%) Multiple abscess 2/15 (13.3%) Right lobe 13/15 (86.7%) Left lobe 1/15 (6.7%) Both lobes 1/15 (6.7%)Image studies (n=15)
Abdominal Sonography 12/15 (80 %) Computed tomography 13/15 (86.7 %) Either one 15/15 (100 %)Culture
Culture Findings Blood culture 3/15 Klebsiella pneumoniae 2 Pseudomonas aureginosa 1 Pus culture 12/14 Mixed infection 2/12 Single pathogen 10/12 Klebsiella pneumoniae 6/12 Streptococcus spp. 6/12 Streptococcus constellatus 2/6 Streptococcus intermedius 2/6 Streptococcus viridans 2/6 Others 2/12Treatment
Treatment
Antibiotics 15/15
Initial Sensitive 10/15
Duration Total 33.1 ± 9.3 days (15-51) IV form 19.9 ± 6.8 days (10-30) Oral form 13.2 ± 7.2 days (0-22)
Intervention 14/15
PAD* 12/14
Days while PAD 3.6 ± 2.3 days (1-9) Open Surgery 1/14
Sonography guide aspiration 1/14
