Pyogenic liver abscess caused by Burkhoderia pseudomallei in Taiwan

Yu Lin Lee, Susan Shin Jung Lee, Hung Chin Tsai, Yao Shen Chen, Shue Ren Wann, Chih Hsiang Kao, Yung Ching Liu

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Pyogenic liver abscess in Taiwan is a well-known disease entity, commonly associated with a single pathogen, Klebsiella pneumoniae. Melioidosis is an endemic disease in Taiwan that can manifest as multiple abscesses in sites including the liver. We report three cases of liver abscesses caused by Burkholderia pseudomallei. The first patient was a 54-year-old diabetic woman, who presented with liver abscess and a left subphrenic abscess resulting from a ruptured splenic abscess, co-infected with K. pneumoniae and B. pseudomallei. The second patient, a 58-year-old diabetic man, developed bacteremic pneumonia over the left lower lung due to B. pseudomallei with acute respiratory distress syndrome, and relapsed 5 months later with bacteremic abscesses of the liver, spleen, prostate and osteomyelitis, due to lack of compliance with prescribed antibiotic therapy. The third patient was a 61-year-old diabetic man with a history of travel to Thailand, who presented with jaundice and fever of unknown origin. Liver and splenic abscesses due to B. pseudomallei were diagnosed. A high clinical alertness to patients' travel history, underlying diseases, and the presence of concomitant splenic abscess is essential to early detection of the great mimicker, melioidosis. The treatment of choice is intravenous ceftazidime for at least 14 days or more. An adequate duration of maintenance oral therapy, with amoxicillin-clavulanate or trimethoprim-sulfamethoxazole for 12-20 weeks, is necessary to prevent relapse. Liver abscess in Taiwan is most commonly due to K. pneumoniae, but clinicians should keep in mind that this may be a presenting feature of melioidosis.

Original languageEnglish
Pages (from-to)689-693
Number of pages5
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume105
Issue number8
Publication statusPublished - Aug 2006
Externally publishedYes

Keywords

  • Burkholderia pseudomallei
  • Klebsiella pneumoniae
  • Liver abscess
  • Melioidosis
  • Spleen abscess

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Lee, Y. L., Lee, S. S. J., Tsai, H. C., Chen, Y. S., Wann, S. R., Kao, C. H., & Liu, Y. C. (2006). Pyogenic liver abscess caused by Burkhoderia pseudomallei in Taiwan. Journal of the Formosan Medical Association = Taiwan yi zhi, 105(8), 689-693.