Division of Pediatric Infectious Diseases, Department of Pediatrics, China Medical University Hospital, China Medical University School of Medicine, Taichung, Taiwan.
Division of Pediatric Infectious Diseases, Department of Pediatrics, China Medical University Hospital, China Medical University School of Medicine, Taichung, Taiwan.
J Microbiol Immunol Infect. 2015 Jun;48(3):302-5. doi: 10.1016/j.jmii.2013.08.009. Epub 2013 Oct 2.
Pediatric pyogenic liver abscess is uncommon. This study aimed to investigate the clinical characteristics, radiologic features, pathogens, duration of hospitalization, and management of pediatric pyogenic liver abscess.
Pediatric patients with pyogenic liver abscess admitted to the China Medical University Hospital from 1995 to 2011 were reviewed. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analyzed. Those with liver abscess due to the complication of oncologic disease were excluded.
Fifteen patients were diagnosed with pyogenic liver abscess. Their most common symptoms were fever and abdominal pain. Eight (53.0%) had leukocytosis (>15000/μL) and elevated C-reactive protein (CRP) level (>10 mg/dL). The main imaging presentation was a single abscess in right lobe of the liver (13/15, 86.7%). Blood culture were mainly negative (12/15, 80.0%). Pathogenic microorganisms cultured from pus revealed Klebsiella pneumoniae (6/15, 40.0%) and Streptococcus spp. (6/15, 40.0%) as the two most common pathogens. Percutaneous abscess drainage followed by adequate parenteral antibiotics were effective interventions. Hospitalization of at least 2 weeks was needed in most cases. There were no mortalities.
Pyogenic liver abscess should be considered in children presenting with fever, abdominal pain, and leukocytosis with a high CRP level. Most cases involve a single lesion on right lobe of the liver. K. pneumoniae and Streptococcus spp. are the two most common pathogens. Drainage with adequate antibiotics has significantly good response.
小儿化脓性肝脓肿并不常见。本研究旨在探讨小儿化脓性肝脓肿的临床特征、影像学特征、病原体、住院时间和治疗方法。
回顾性分析 1995 年至 2011 年在中国医科大学附属盛京医院住院的小儿化脓性肝脓肿患者。分析其临床特征、影像学特征、实验室数据、临床治疗及转归。排除因合并肿瘤性疾病而导致肝脓肿的患者。
共 15 例小儿化脓性肝脓肿患者被诊断为小儿化脓性肝脓肿。最常见的症状是发热和腹痛。白细胞增多症（>15000/μL）和 C 反应蛋白（CRP）水平升高（>10mg/dL）的患者有 8 例（53.0%）。主要影像学表现为右叶单发脓肿（13/15，86.7%）。血培养主要为阴性（12/15，80.0%）。脓液培养的病原菌主要为肺炎克雷伯菌（6/15，40.0%）和链球菌属（6/15，40.0%）。经皮脓肿引流术联合充分的静脉抗生素治疗是有效的干预措施。大多数患者需要至少 2 周的住院时间。无死亡病例。
对于发热、腹痛、白细胞增多症伴高 CRP 水平的儿童，应考虑化脓性肝脓肿。大多数病例涉及右叶单发病变。肺炎克雷伯菌和链球菌属是最常见的两种病原体。引流联合充分的抗生素治疗具有良好的疗效。
