Liver Abscess

fever with right sided abdominal pain
  • Aakriti Pandita
  • Waleed Javaid
  • Tasaduq Fazili


Liver abscesses are relatively uncommon. The clinical presentation includes fever and right upper quadrant abdominal pain. The most common etiologic agents include Staphylococcus aureus, a variety of enteric gram-negative bacilli, and the protozoan parasite Entamoeba histolytica. In recent years, the observed increase in reported cases caused by Klebsiella pneumoniae has gained attention because of their association with metastatic complications. The management of a patient with a bacterial liver abscess almost always involves a drainage procedure followed by a relatively long course of intravenous antibiotics. Amoebic abscesses are managed medically using a combination of two amoebicides, one to treat the parenchymal liver infection and the other to eradicate any residual intraluminal (intraintestinal) amoeba. Drainage procedures are not usually necessary for diagnostic or therapeutic purposes.


Liver abscess Klebsiella pneumoniae Escherichia coli Salmonella species Entamoeba histolytica Chronic granulomatous disease 


  1. 1.
    Lee KT, Wong SR, Sheen PC. Pyogenic liver abscess: an audit of 10 years’ experience and analysis of risk factors. Dig Surg. 2001;18(6):459–65. discussion 465–6.CrossRefGoogle Scholar
  2. 2.
    Huang C-J, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, et al. Pyogenic hepatic abscess. Ann Surg. 1996;223(5):600–9.CrossRefGoogle Scholar
  3. 3.
    Lardière-Deguelte S, Ragot E, Amroun K, Piardi T, Dokmak S, Bruno O, et al. Hepatic abscess: diagnosis and management. J Visc Surg. 2015;152(4):231–43.CrossRefGoogle Scholar
  4. 4.
    Murarka S, Pranav F, Dandavate V. Pyogenic liver abscess secondary to disseminated streptococcus anginosus from sigmoid diverticulitis. J Global Infect Dis. 2011;3(1):79–81.CrossRefGoogle Scholar
  5. 5.
    Law S-T. Is hepatic neoplasm-related pyogenic liver abscess a distinct clinical entity? World J Gastroenterol. 2012;18(10):1110.CrossRefGoogle Scholar
  6. 6.
    Kumar D, Ramanathan S, Al Faki A, Nepal P. Faecolith migrating from the appendix to produce liver abscess after subhepatic laparoscopic appendectomy. Trop Dr. 2015;45(4):241–4.Google Scholar
  7. 7.
    Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005;100(2):322–31.CrossRefGoogle Scholar
  8. 8.
    Fazili T, Sharngoe C, Endy T, Kiska D, Javaid W, Polhemus M. Klebsiella pneumoniae liver abscess: an emerging disease. Am J Med Sci. 2016;351(3):297–304.CrossRefGoogle Scholar
  9. 9.
    Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39(11):1654–9.CrossRefGoogle Scholar
  10. 10.
    Wong W-M, Wong BCY, Hui CK, Ng M, Lai KC, Tso WK, et al. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period. J Gastroenterol Hepatol. 2002;17(9):1001–7.CrossRefGoogle Scholar
  11. 11.
    Siu LK, Kristopher Siu L, Yeh K-M, Lin J-C, Fung C-P, Chang F-Y. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881–7.CrossRefGoogle Scholar
  12. 12.
    Chen C-H, Wu S-S, Chang H-C, Chang Y-J. Initial presentations and final outcomes of primary pyogenic liver abscess: a cross-sectional study. BMC Gastroenterol [Internet]. 2014;14(1). Available from:
  13. 13.
    Keller JJ, Tsai M-C, Lin C-C, Lin Y-C, Lin H-C. Risk of infections subsequent to pyogenic liver abscess: a nationwide population-based study. Clin Microbiol Infect. 2013;19(8):717–22.CrossRefGoogle Scholar
  14. 14.
    Qu K. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia. World J Gastroenterol. 2012;18(23):2948.CrossRefGoogle Scholar
  15. 15.
    Tian L-T, Yao K, Zhang X-Y, Zhang Z-D, Liang Y-J, Yin D-L, et al. Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China. Clin Microbiol Infect. 2012;18(9):E314–30.CrossRefGoogle Scholar
  16. 16.
    Lin J-N, Lin C-L, Lin M-C, Lai C-H, Lin H-H, Kao C-H. Pyogenic liver abscess in patients with inflammatory bowel disease: a nationwide cohort study. Liver Int. 2016;36(1):136–44.CrossRefGoogle Scholar
  17. 17.
    Dwivedi S. Multi-organ failure secondary to a clostridium perfringens gaseous liver abscess following a self-limited episode of acute gastroenteritis. Am J Case Rep. 2015;16:182–6.CrossRefGoogle Scholar
  18. 18.
    Jeong SW, Jang JY, Lee TH, Kim HG, Hong SW, Park SH, et al. Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol. 2012;27(2):248–55.CrossRefGoogle Scholar
  19. 19.
    Molle I. Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark. Gut. 2001;48(2):260–3.CrossRefGoogle Scholar
  20. 20.
    Lin Y-T, Liu C-J, Chen T-J, Chen T-L, Yeh Y-C, Wu H-S, et al. Pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Am J Med. 2011;124(12):1158–64.CrossRefGoogle Scholar
  21. 21.
    Mavilia MG, Molina M, Wu GY. The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol. 2016;4(2):158–68.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Tsai M-S, Lee H-M, Hsin M-C, Lin C-L, Hsu C-Y, Liu Y-T, et al. Increased risk of pyogenic liver abscess among patients with colonic diverticular diseases. Medicine. 2015;94(49):e2210.CrossRefGoogle Scholar
  23. 23.
    Lai H-C. Pyogenic liver abscess associated with large colonic tubulovillous adenoma. World J Gastroenterol. 2006;12(6):990.CrossRefGoogle Scholar
  24. 24.
    Lai H-C, Lin H-C. Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study. Liver Int. 2010;30(9):1387–93.CrossRefGoogle Scholar
  25. 25.
    Gross RG, Reiter B, Korsten MA. Pyogenic liver abscess complicating colonoscopic polypectomy. Gastrointest Endosc. 2008;67(4):767–8.CrossRefGoogle Scholar
  26. 26.
    Morimoto M, Numata K, Kondo M, Moriya S, Morita S, Maeda S, et al. Radiofrequency ablation combined with transarterial chemoembolization for subcapsular hepatocellular carcinoma: a prospective cohort study. Eur J Radiol. 2013;82(3):497–503.CrossRefGoogle Scholar
  27. 27.
    Shin JU, Kim KM, Shin SW, Min SY, Park SU, Sinn DH, et al. A prediction model for liver abscess developing after transarterial chemoembolization in patients with hepatocellular carcinoma. Dig Liver Dis. 2014;46(9):813–7.CrossRefGoogle Scholar
  28. 28.
    Hoffmann R, Rempp H, Schmidt D, Pereira PL, Claussen CD, Clasen S. Prolonged antibiotic prophylaxis in patients with Bilioenteric anastomosis undergoing percutaneous radiofrequency ablation. J Vasc Interv Radiol. 2012;23(4):545–51.CrossRefGoogle Scholar
  29. 29.
    Pastagia M, Arumugam V. Klebsiella pneumoniae liver abscesses in a public hospital in queens, New York. Travel Med Infect Dis. 2008;6(4):228–33.CrossRefGoogle Scholar
  30. 30.
    Wang J, Liu Y, Lee SS, Yen M, Chen Y, Wang J, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26(6):1434–8.CrossRefGoogle Scholar
  31. 31.
    Chen S-C, Wu W-Y, Lai K-C, Lee M-C, Wang P-H, Chen C-C, et al. Comparison of Escherichia coli and Klebsiella pneumoniae liver abscesses. Am J Med Sci. 2007;334(2):97–105.CrossRefGoogle Scholar
  32. 32.
    Morii K, Kashihara A, Miura S, Okuhin H, Watanabe T, Sato S, et al. Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae. Clin J Gastroenterol. 2012;5(2):136–40.CrossRefGoogle Scholar
  33. 33.
    Margo CE, Mames RN, Guy JR. Endogenous Klebsiella Endophthalmitis. Ophthalmology. 1994;101(7):1298–301.CrossRefGoogle Scholar
  34. 34.
    Sheu S-J, Kung Y-H, Wu T-T, Chang F-P, Horng Y-H. Risk factors for endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan. Retina. 2011;31(10):2026–31.CrossRefGoogle Scholar
  35. 35.
    Fung C-P. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut. 2002;50(3):420–4.CrossRefGoogle Scholar
  36. 36.
    Liu Y, Wang J-Y, Jiang W. An increasing prominent disease of Klebsiella pneumoniae liver abscess: etiology, diagnosis, and treatment. Gastroenterol Res Pract. 2013;2013:258514.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Turton JF, Baklan H, Siu LK, Kaufmann ME, Pitt TL. Evaluation of a multiplex PCR for detection of serotypes K1, K2 and K5 in Klebsiella sp. and comparison of isolates within these serotypes. FEMS Microbiol Lett. 2008;284(2):247–52.CrossRefGoogle Scholar
  38. 38.
    Alsaif HS, Venkatesh SK, Chan DSG, Archuleta S. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae. Radiology. 2011;260(1):129–38.CrossRefGoogle Scholar
  39. 39.
    Yang C-C, Yen C-H, Ho M-W, Wang J-H. Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae. J Microbiol Immunol Infect. 2004;37(3):176–84.PubMedGoogle Scholar
  40. 40.
    Lee NK, Kim S, Lee JW, Jeong YJ, Lee SH, Heo J, et al. CT differentiation of pyogenic liver abscesses caused by Klebsiella pneumoniae vs non -Klebsiella pneumoniae. Br J Radiol. 2011;84(1002):518–25.CrossRefGoogle Scholar
  41. 41.
    Tatsuta T, Wada T, Chinda D, Tsushima K, Sasaki Y, Shimoyama T, et al. A case of gas-forming liver abscess with diabetes mellitus. Intern Med. 2011;50(20):2329–32.CrossRefGoogle Scholar
  42. 42.
    Lin Y-T, Wang F-D, Wu P-F, Fung C-P. Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics. BMC Infect Dis [Internet]. 2013;13(1). Available from:
  43. 43.
    Hagiya H, Kuroe Y, Nojima H, Otani S, Sugiyama J, Naito H, et al. Emphysematous liver abscesses complicated by septic pulmonary emboli in patients with diabetes: two cases. Intern Med. 2013;52(1):141–5.CrossRefGoogle Scholar
  44. 44.
    Stanley SL. Amoebiasis. Lancet. 2003;361(9362):1025–34.CrossRefGoogle Scholar
  45. 45.
    Lübbert C, Wiegand J, Karlas T. Therapy of liver abscesses. Viszeralmedizin. 2014;30(5):334–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Aakriti Pandita
    • 1
  • Waleed Javaid
    • 2
  • Tasaduq Fazili
    • 2
  1. 1.SUNY Upstate Medical University, Department of MedicineSyracuseUSA
  2. 2.SUNY Upstate Medical University, Department of Medicine, Division of Infectious DiseasesSyracuseUSA

Personalised recommendations