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He was discharged 17?days after admission and was afebrile with a normal white cell count and improving ALP, bilirubin and aminotransferases. Outcome and follow-up On follow-up in the infectious disease clinic 1?month later, his white cell count remained within normal limits and C reactive protein (CRP) ALP, bilirubin, ALT and AST levels continued to improve. Amoxicillin-clavulanate was continued for a total of 6?weeks of therapy and repeat CT 2 months after discharge demonstrated resolution of the abscesses and bowel wall thickening. Discussion PLA is a potentially life-threatening infection. At 48% of intra-abdominal visceral abscesses, the liver is the most common site of occurrence.8 The annual incidence is estimated to be 2.3/100?000 population.9 Risk factors for liver abscess include hepatobiliary Ruxolitinib infection, pancreatic disease, diabetes and prior liver transplant.10�C12 Abscesses may also result from hematogenous seeding from the systemic circulation, gallstones or malignant obstruction.10 13 14 Peritonitis secondary to bowel perforation and subsequent spread through the portal circulation is also a common aetiology. Abscesses most commonly affect the right liver lobe, likely secondary to the larger size and blood supply. Patients often present with fever and abdominal pain. Although fever is common in PLA, abdominal pain may only be present in 50�C75% of patients.10 13 Laboratory abnormalities usually include elevated bilirubin, ALP and aminotransferases.10 13 Leukocytosis and elevated CRP may also be present. Although CT is the imaging of choice, it is non-specific and is often unable to distinguish between hepatic abscess, amoebic abscess and malignancy. Blood cultures should be obtained, since they may be positive in up to 50% of cases.15 PLA is usually polymicrobial and the pathogens may depend on the underlying aetiology of the abscess.10 Mixed enteric facultative and anaerobic species are the most commonly reported pathogens. Streptococcus milleri, Streptococcus. anginosus, Streptococcus. intermedius, and Streptococcus. constellatus have all been isolated.16 These organisms may be metastatic from a primary source, such as oral and orthodontic, head and neck, or thoracic infections; the S anginosus group can also cause endocarditis.17�C20 Isolation of these organisms may warrant further investigation for a primary site. Staphylococcus aureus and Streptococcus pyogenes have been isolated in PLA and were reported in patients who underwent transarterial embolisation for hepatocellular carcinoma.21 Candida species have also been isolated and are often found in patients receiving chemotherapy.10 Klebsiella pneumoniae is another known pathogen and is increasing in incidence.22 Amoebiasis should also be on the differential for primary liver abscess, especially if there is any relevant travel history. Finally, actinomycosis is a rare cause of PLA.5�C7 Actinomyces spp.