The Diagnosis And Treatment Of Bacterial Liver Abscess In Diabetics: Clinical Analysis Of 19 Cases

1. BackgroundBacterial liver abscess is one of severe infectious liver diseases, which could be occurred through many paths by vary kinds of pathogens. Recently, the incidence of latent liver abscess has been increased, and 25% of the patients are companied with diabetes mellitus. The clinical manifestations of bacterial liver abscess in diabetics (DLA) are frequently atypical, and also serious, and often misdiagnosis. Realizing the clinical features of DLA accurately could help us to make with correct diagnosis and treatment, which may contribute to improve the prognosis of DLA.2. Objective:To investigate the clinical characteristics and therapeutic strategy of bacterial liver abscess in diabetics (DLA).3. Methods:19 cases of DLA were retrospectively reviewed. The factors which we analysed were included among the clinical presentation, the other diseases companied withDLA, the general laboratory examination, bacterial culture, the position of abscess in liver, the therapeutic methods and curative effect of treatment.4. Results:19 cases of DLA were all type 2 diabetes mellitus, and DLA occurred more frequently in elderly patients with hyperglycemia. Among the 19 cases, 12 of them were males. The abscess focuses were predilection for right liver occupied, and most of which were single. Clinical features of this disorder were atypical, the occurrence of the right upper abdominal pain was not common, however the hepatic dysfunction did often happen. The positive rate of bacteria cultivation in blood, puncture fluids and other sources was lower (36.8%). Klebsiella pneumoniae and Escherichia cloi were the major pathogens in DLA. The B-ultrasonography and Computer tomography of liver played an important role in the diagnosis of DLA. 13 cases were treated by antibiotics along, and 5 cases submitted to aspiration by the guiding of B-ultrasonography, and 1 case underwent surgical drainage of liver abscess. Among 19 cases, 18 of them were curved successfully.5. Conclusions:The clinical features of DLA are atypical, and also companied with many complications, which might result in the difficulty of the diagnosis of DLA. We should pay attention to the patients who suffered from diabetes mellitus with the symptom of fever. It is of coequal importance for the treatment to DLA that both infection and hyperglycemia are controlled well. Appropriate therapeutic strategies include early diagnosis, control of hyperglycemia with insulin, sufficient use course ofantibiotics and timely drainage of abscess.