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11 : The Emerging Role of Klebsiellae in Liver Abscess

Authors: Joseph Rahimian1, Jin-Town Wang2
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Affiliations: 1: Department of Infectious Diseases, St. Vincent’s Hospital, New York, NY 10011; 2: Department of Microbiology, National Taiwan University Hospital, Taipei 10016, Taiwan
Content Type: Monograph
Publication Year: 2007

Category: Clinical Microbiology

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Abstract:

The majority of organisms involved in pyogenic liver abscess (PLA) originate from the gastrointestinal tract. The study by Huang et al. suggested that Klebsiella was becoming a more common pathogen in cases of PLA. Also of interest was the fact that in the majority of cases in which Klebsiella was recovered, it was the only pathogen. Therefore, the percentage of PLA cases caused by alone was substantially greater in this study than in any prior study from the United States. However, in recent years, bacterial virulence has been found to play an important role in the pathogenesis of the disease. A multinational prospective study revealed a global difference in clinical patterns of community-acquired bacteremia, with a distinctive form of infection causing liver abscess, endophthalmitis, and meningitis almost exclusively in Taiwan. The most common signs and symptoms of PLA are fever, right upper quadrant pain, and chills. The most common laboratory abnormalities are a low albumin level, elevated alkaline phosphatase, and an elevated white blood cell count. The majority of patients have lesions in the right lobe of the liver. While cases of pyogenic liver abscesses have been reported in the literature for many years, there have been many changes in the epidemiology of the disease. Recently, virulence factors, such as that encoded by the magA gene, have been identified. Strains with magA are also strongly associated with metastatic complications, such as endophthalmitis and meningitis.

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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The Emerging Role of Klebsiellae in Liver Abscess
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Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
/content/10.1128/9781555815585.ch11.ch11fig01
Figure 1.
Changing epidemiology of pyogenic liver abscess in Taiwan. The graph shows the percentage of among pyogenic liver abscesses in Taiwan.
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10.1128/9781555815585/f0202-01.gif
Image of Figure 1.
Figure 1.

Changing epidemiology of pyogenic liver abscess in Taiwan. The graph shows the percentage of among pyogenic liver abscesses in Taiwan.

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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Figure 2.
Pathogen-specific incidence of adult community-acquired bacterial meningitis diagnosed at National Taiwan University Hospital during the periods from 1993 to 1994, 1995 to 1996, and 1997 to 1998.
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10.1128/9781555815585/f0204-01.gif
Image of Figure 2.
Figure 2.

Pathogen-specific incidence of adult community-acquired bacterial meningitis diagnosed at National Taiwan University Hospital during the periods from 1993 to 1994, 1995 to 1996, and 1997 to 1998.

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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Figure 3.
(A and B) Histopathology in the liver and brain of a mouse inoculated with 10 CFU of NTUH-K2044, examined on day 9 after inoculation (hematoxylin and eosin stain; magnification, ×100 [A] versus ×200 [B]). (C and D) Histopathology in the liver and brain of a mouse inoculated with 10 CFU of mutant, examined on day 9 after inoculation (hematoxylin and eosin stain; magnification, ×100). Panels A and B show severe meningitis and liver microabscess; panels C and D show normal histology.
10.1128/9781555815585/f0205-01_thmb.gif
10.1128/9781555815585/f0205-01.gif
Image of Figure 3.
Figure 3.

(A and B) Histopathology in the liver and brain of a mouse inoculated with 10 CFU of NTUH-K2044, examined on day 9 after inoculation (hematoxylin and eosin stain; magnification, ×100 [A] versus ×200 [B]). (C and D) Histopathology in the liver and brain of a mouse inoculated with 10 CFU of mutant, examined on day 9 after inoculation (hematoxylin and eosin stain; magnification, ×100). Panels A and B show severe meningitis and liver microabscess; panels C and D show normal histology.

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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Figure 4.
Sequences of the flanking region revealed a 33-kb fragment, which was replaced with a 28-kb fragment in MGH78578.
10.1128/9781555815585/f0206-01_thmb.gif
10.1128/9781555815585/f0206-01.gif
Image of Figure 4.
Figure 4.

Sequences of the flanking region revealed a 33-kb fragment, which was replaced with a 28-kb fragment in MGH78578.

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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Figure 5.
Histological examination of the livers and brains of mice. was given to mice by intragastric inoculation at a dose of 10 CFU. (A and B) Mice inoculated with NTUH-K2044. (C and D) Mice inoculated with MGH 78578. (A) Severe liver abscess (hematoxylin and eosin stain; magnification, ×40). (B) Meningitis and brain abscess (hematoxylin and eosin stain; magnification, ×100). (C and D) Normal histology (hematoxylin and eosin stain; magnification, ×100).
10.1128/9781555815585/f0207-01_thmb.gif
10.1128/9781555815585/f0207-01.gif
Image of Figure 5.
Figure 5.

Histological examination of the livers and brains of mice. was given to mice by intragastric inoculation at a dose of 10 CFU. (A and B) Mice inoculated with NTUH-K2044. (C and D) Mice inoculated with MGH 78578. (A) Severe liver abscess (hematoxylin and eosin stain; magnification, ×40). (B) Meningitis and brain abscess (hematoxylin and eosin stain; magnification, ×100). (C and D) Normal histology (hematoxylin and eosin stain; magnification, ×100).

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
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Tables

The Emerging Role of Klebsiellae in Liver Abscess
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Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11
/content/10.1128/9781555815585.ch11.ch11tab01
Table 1.
Characteristics of PLA studies
Generic image for table
Table 1.

Characteristics of PLA studies

Citation: Rahimian J, Wang J. 2007. The Emerging Role of Klebsiellae in Liver Abscess, p 199-214. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch11

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