Pyogener Leberabszess: Erregerprofil und Konsequenzen für Diagnostik und Therapie

Abstract

Liver abscess is a rare but potentially fatal disease with mortality rates of 2 – 12 %. The spectrum of causative microorganisms varies across the world and is changing due to increasing worldwide travel activity. As a result, previously less frequent pathogens must increasingly be considered in the differential diagnosis. The most common pathogens of liver abscess are so-called abscess streptococci, anaerobes and Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Certain clones among the Gram-negatives, typically among Klebsiella spp., harbour specific virulence factors and are therefore referred to as hypervirulent clones which spread worldwide. In any case, the causative agent should be identified before anti-infective treatment is initiated. Several pathogens such as Candida spp., Pseudomonas aeruginosa or Staphylococcus aureus are uncommon and only detected in a specific context. Various therapeutic regimens are available for anti-infective therapy. Usually an empirical therapy is started, combining mostly β-lactam antibiotics or quinolones with anaerobically active substances.

Aufgrund des stark angestiegenen internationalen Reiseverkehrs sind immer mehr seltene Erregertypen in die Diagnose bei infektiösen Erkrankungen einzubeziehen. So kann die Infektion durch Entamoeba histolytica und zunehmend auch seltenere bakterielle Erreger einschließlich Parasiten zu einem Leberabszess führen. Die Inzidenz liegt in der westlichen Welt zwar bei < 5/100 000 Einwohner pro Jahr, die Erkrankung kann aber trotz aller medizinischen Fortschritte drastisch verlaufen.

Schlüsselwörter

Leberabszess - Differenzialdiagnose - hypervirulente Klebsiella pneumoniae - perkutane Drainage - Amöbenleberabszess

Keywords

liver abscess - differential diagnosis - hypervirulent Klebsiella pneumoniae - percutaneous drainage - amoebic liver abscess

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