Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature.

The changing demographics of splenic abscess in regard to predisposition, clinical setting, diagnosis, bacteriologic findings, and treatment have been presented based on 19 patients from five institutions and 170 patients reported in the literature since 1978. These data, in turn, have been compared with a previously published retrospective review of the world literature from 1900 to 1977. It has become clear that since 1978, splenic abscess is diagnosed earlier in its presentation due to the widespread use of improved imaging techniques, immunocompromised patients comprise a much larger proportion of patients (24 percent) than previously due to increasing use of steroids and chemotherapeutic agents, and the diagnosis of fungal splenic abscess, almost unheard of before 1978, has increased to 26 percent of patients. The diagnostic sensitivity of computerized tomography (96 percent) has clearly been shown to be superior to ultrasonography, and gallium, indium, and technetium-99m liver and spleen scanning. The diagnosis of splenic abscess, however, is still often not considered due to its rarity and the presence of predisposing conditions which obscure its clinical presentation. Untreated splenic abscess is still fatal, and although splenectomy is the mainstay of treatment, it appears that antifungal treatment without splenectomy can be recommended for patients with disseminated fungal disease as long as bacterial abscess has been ruled out by invasive culture techniques. Scattered reports of percutaneous drainage exist and are increasing in the literature, although the results are as yet inconclusive. Eventual recovery depends on early diagnosis and successful treatment of the underlying condition.