Invasive liver abscess syndrome caused by Klebsiella pneumoniae

Definition- K. pneumoniae primary liver abscess as liver abscess that occurs in the absence of hepatobiliary disease. Almost all of these infections are monomicrobial

In a review of 160 cases from Taiwan,

• Fever (93 percent)
• Right upper quadrant tenderness (71 percent)
• Nausea, vomiting, diarrhea, or abdominal pain (38 percent)
• Leukocytosis (70 percent)
• Elevations in serum alanine and aspartate aminotransferases (59 and 68 percent)
• Elevations in alkaline phosphatase (78 percent)
• Elevations in bilirubin (26 percent)

 more likely to be solitary and more likely to be monomicrobial

minority of patients -develops metastatic infection at other sites  - metastatic infection are endophthalmitis, meningitis and brain abscess , Other manifestations include lumbar or cervical spondylitis and discitis, septic pulmonary emboli, lung abscess, psoas abscess, splenic abscess, necrotizing fasciitis, neck abscess, and osteomyelitis

  The differential diagnosis of fever and right upper quadrant abdominal pain includes other hepatobiliary disease, colitis, or pneumonia.

necrosis of hepatic tumor can appear similar to a highly suppurative abscess on CT.
diffusion-weightedMRI  may be useful

Although aminoglycosides penetrate abscess cavities poorly, in theory they may eradicate bloodstream organisms early in the course of infection, potentially decreasing risk for metastatic complications. unproven

In general, treatment should be continued until CT imaging demonstrates complete or near complete resolution of the abscess cavity. Some abscesses with a thick capsule
 other clinical findings, such as normalization of inflammatory markers, sterile cultures, and the finding of a clear cavity without debris or other content on imaging, can be helpful to distinguish this from persistent infection.

 Treatment of metastatic infection — In addition to systemic antibiotics, local therapy or debridement may be required in patients with metastatic infection. As an example, patients with Klebsiella endophthalmitis should receive intravitreal antibiotics and vitrectomy.

Prognosis-  Taiwan:

• 160 cases of KLA, mortality rate was 11 %and relapse  4.4 %. significantly higher (41%) in 22 patients with polymicrobial liver abscess,
•   metastatic endophthalmitis - have impaired vision or blindness. patients with meningitis may have persistent neurologic abnormalities