Compared with other bacterial abscesses ...

In this case, select a specific aspect of Klebsiella pneumonia liver abscess occurring disease in the United States and Western countries. We announce two cases of Asian patients with Klebsiella liver abscesses associated estimated in our institute for one year. Both >> << are non-specific symptoms at presentation, a kind of ultrasonic appearance >> << and successful treatment of early percutaneous drainage. Klebsiella related liver abscess occurring disease with particular clinical characteristics. As

compared to other bacterial liver abscesses, Klebsiella pneumonia

Related festering abscesses of liver has different risk factors unique ultrasound

and computed tomography features and different prognoses. Abscess liver abscess (PLA) is a potentially life-threatening disease that can be caused by >> << bacterial or fungal organisms. The most common bacteria isolated from liver abscess patients

Gram-negative bacillus. By the end of last century,

E. coli was recognized as the main cause of bacterial abscesses liver [], but recently >> << Klebsiella pneumonia was the leading agent in Asian and Western countries [

]. Here we describe two cases of Klebsiella associated PLA have been investigated and successfully treated in our department. 29-year old Indian man reported the 4-day history of fever, chills and fatigue. He

previously been in good health. He emigrated to Italy nine years ago. He denied

latest trip abroad. On general examination the temperature is 40 `C, lung, heart and abdominal examinations

found no abnormalities. Laboratory tests differed leukocytosis (14 040

cells / mm

), total bilirubin 1. 6 mg / dL, alanine transferase 100 U / L, aspartate transferase-69

U / L. Chest X-ray showed increased right right or left dome of diaphragm. The patient was empirically

received intravenous levofloxacin and ceftriaxone, but the peaks of fever persists. Three days after admission the patient developed right upper quadrant abdominal pain >>. << Abdominal ultrasound (U.S.) showed a diameter of 10 cm lesion in right lobe

liver. Computed tomography (CT) showed a 10 cm hypodense lesion with

internal partitions (Fig.

). US-guided percutaneous drainage was placed 150 ml of purulent brings fluid

but no pathogen was isolated from the culture atmosphere manure. Entamoeba histolytica serology was negative. Two of three blood cultures grew Klebsiella pneumonia

resistant to levofloxacin. Thus, the patient intravenous gentamicin strattera price and metronidazole

. This therapy led to clinical improvement and percutaneous drainage has been deleted. Abdominal U.S. to extract showed a significant reduction in size of the abscess. The patient was discharged

antibiotics were switched to oral ciprofloxacin and metronidazole

6-week course. Further U.S. after antibiotic therapy showed resolution

abscess. The patient turned to his normal health. 76 year old Chinese presented a 5-day history of fever spikes and chills. Previously, he was in good health, history found >> << cholecystectomy for cholelithiasis ten years ago. Overview showed significant hypotension (85/50 mmHg) and temperature >> << 41 `C, while others consider it was nothing remarkable. Laboratory tests showed elevated

C-reactive protein (31 mg / dl, normal value1), violation of serum creatinine

(1. 8 mg / dL), aspartate-transferase (139 U / L), alanine transferase (110 U / L), alkaline phosphatase

(823 U / L) and total bilirubin (2. 12 mg / dl). The patient was treated with

fluid and empirical antibiotic therapy with piperacillin-tazobaktam started. Abdominal U.S. showed 3 cm in diameter lesion in the right lobe of liver. Abdominal

CT confirmed the presence of 3 cm hypodense lesion with irregular fields strongly

suspicious metastatic tumor liver. Percutaneous catheter drainage was made. Diagnostic aspiration lesions given 50 ml of purulent material grew Klebsiella pneumonia

. Three blood cultures grew Klebsiella pneumonia

sensitive to all antibiotics. Entamoeba histolytica serology was negative. Clinical conditions of patients improved, abdominal U.S. to discharge showed complete resolution of liver abscess

. The patient was discharged and treatment on an outpatient basis with

levofloxacin and metronidazole for 4 weeks. First reported from Taiwan as a single organism in PLA [], recent research

Klebsiella pneumonia was recognized as the leading agent of PLA in Asia and Western countries [

]. In addition, it was found that due to the Asian ethnicity, diabetes

and liver abscesses kryptohennyy

[,,

]. On the other hand, the presence of cholelithiasis and malignant coexisting been recognized as an intellectual

parameter E. coli PLA []. Patients often complain of indefinite constitutional symptoms such as fever and fatigue,

still only half the battle represented a specific clinical clues right upper quadrant

pain, jaundice and hepatomegaly

[

]. Only non-specific symptoms were found in our case, even in the first >> << patient who was so large PLA (10 cm). For this reason, the absence of the upper right abdominal quadrant

results do not rule out liver abscess. In addition to NOAK

always be considered in the differential diagnosis of fever of unknown origin. Distinctive features of U.S. and CT have been reported in Klebsiella pneumonia PLA [

]. Mostly solid U.S. appearance of lesions with irregular margins observed in

Klebsiella related liver abscesses, probably because of their refusal liquefaction

[]. Compared with other bacterial abscesses, fewer pus obtained at initial aspiration

reported in the

Klebsiella PLA [], which may be related to their preferred dense consistency of aggregation

in a few cells that do not communicate. These features are observed in our patients,

especially in the second, where the liver, the tumor was considered in the diagnosis >> << differ. Some studies have shown a better prognosis for patients with Klebsiella associated PLA than for other bacterial abscesses liver [

]. However, a higher frequency of metastases to other sites of infection has been shown in patients with

Klebsiella associated PLA []. The most common manifestation of metastatic infection endoftalmitu, meningitis and

brain abscess []. The main factors of virulence of Klebsiella pneumonia

been shown to be associated with metastatic disease. K1 capsule serotype is

important factor for virulence of septic eyes and central nervous system complications

PLA []. In addition a number of clinical studies indicate a connection between >> << hypermucoviscosity phenotype

Klebsiella pneumonia and the presence of invasive disease has spread to infection []. Klebsiella pneumonia strains have hypermucosviscosity phenotype if they are capable of producing

mucoviscous web ekzopolisaharydu. In the microbiological laboratory, these strains

grow in colonies on the sticky cups with agar and identified a line test. Although

diabetes was considered a major risk factor for

Klebsiella associated PLA, data conflict as to whether this is related to invasive and metastatic

infection []. None of our patients with diabetes, none of them felt the eye or neurological complications.

The significant reduction in mortality occurred in all the festering abscesses of liver

since 1950, possibly due to the advent of percutaneous drainage and wide spectrum antibiotics

[]. Unlike amebic abscess, drainage of purulent abscesses should in most cases

This issue highlights Cheng et al. (2003)

[], who noted that early drainage can significantly improve the prognosis. Percutaneous drainage

. is a relatively low risk and effective method. It gradually replaced

surgical procedures, as has been shown to reduce the cost and length of stay in hospital

[]. Surgical drainage should be considered in patients with multiple and large liver abscesses

and if no response to percutaneous drainage

[]. In addition to drainage, treatment

Klebsiella liver abscess requiring parenteral antibiotics. With outpatient

Klebsiella strains resistant to first generation cephalosporins and ampicillin, but rarely

produce extended spectrum beta-lactamase (ESBL), a combination of extended spectrum

beta-lactam and aminoglycosides is the best treatment. Although aminoglycosides

penetrate the abscess cavity is bad, it can quickly eradicate organisms in >> << bloodstream and reduces the risk of metastatic disease. CT: computed tomography; ESBL: extended spectrum beta-lactamases, PLA: Purulent liver abscess

, U.S.: ultrasound. Written informed consent was obtained from patients for publication of these thematic

reports and accompanying images. A copy of the written consent is available for viewing

chief editor of the magazine. The authors declare that they have no competing interests. FC was a major contributor in writing the manuscript; LF participated in the diagnosis and management

disease; VR performed abdominal CT scan; GR is a major >> << contribution to writing the manuscript, MD was involved in the diagnosis and management

disease; TM produced by abdominal ultrasound, Russia was a major contributor in writing

manuscripts. .