Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan

Table 1 Comparison of epidemiology and symptomatology in the reviews

Variable	Chun et al[17] 1900-1977	Nelken et al[5] 1977-1986	Ooi et al[18] 1987-1995	Present study 1986-2004
Number of cases	173	189	287	67
Male:female ratio(%)	104 : 61 (63)	125 :  64 (66)	163 : 80 (67)	41 : 26 (61)
Mean age (yr)	36.8	Not available	41.1	54.1
Age range (yr)	6 mo-83	6 mo-82	6 mo-92	19-79
Clinical presentations
Fever (%)	95.4	84	90.8	85
Left upper quadrant pain(%)	42.1	39	49.8	43.3
Splenomegaly(%)	53.9	40	30.7	67.2
Left pleural effusion(%)	19.7	Not available	22.3	41.5

Table 2 Underlying and predisposing diseases in 67 cases of splenic abscess

Underlying diseases (n = 67)	Solitary(SSA)(n = 48)	Multiple(MSA)(n = 19)	Extrasplenic abscess (n = 26)
DM (20)	17	3	101
Endocarditis (7)	7	0	42
Pancreatitis (5)	2	3	23
Pancreatitis+DM (2)	1	1	0
Pancreatic cancer (1)	1	0	0
Liver cirrhosis (2)	1	1	14
Trauma (2)	1	1	0
MDS (2)	0	2	25
SLE (2)	2	0	0
CHF (1)	1	0	0
Perforated peptic ulcer (1)	1	0	0
Colon perforation+ DM (1)	1	0	16
Endocarditis+DM (1)	1	0	0
Biliary tract stone	1	0	0
AIDS (1)	0	1	17
ALL (1)	0	1	0
Aplastic anemia (1)	1	0	0
ESRD+ovarian cancer (1)	0	1	0
COPD+CHF (1)	1	0	0
Lung cancer+DM (1)	1	0	0
Unknown (13)	8	5	58

DM, diabetes mellitus; MDS, myelodysplastic syndrome; SLE, systemic lupus erythematosus; CHF, congestive heart failure; AIDS, acquired immunodeficiency syndrome; ALL, acute lymphocytic leukemia; ESRD, end stage renal disease; COPD, chronic obstructive pulmonary disease.

¹Liver: 3; subphrenic area: 2; pancreas: 1; anus: 1; gluteal muscle: 1; retroperitoneal cavity: 1; brain+lung: 1.

²brain: 2; aortic valve: 1; lung: 1.

³pancreas: 2.

⁴gluteal muscle: 1.

⁵liver: 2.

⁶subphrenic area: 1.

⁷liver: 1.

⁸liver: 2; brain+lung: 1; retroperitoneal cavity: 1; subphrenic area: 1.

Table 3 Microorganisms of blood culture and abscess culture of splenic abscess

Microorganism (n = 67)	Solitary (n = 48)	Multiple (n = 19)	Extrasplenic abscess (n = 26)
Aerobes
Gram positive-18
Streptococcus viridans (SV) (8)	7	1	21
Staphylococcus aureus (5)	5	0	32
Enterococcus species (5)	5	0	13
Gram negative-32
Escherichia coli (11)	8	3	44
Klebsiella pneumoniae (KP)(10)	4	6	75
Pseudomonas species (PS) (5)	4	1	16
Salmonella species (5)	4	1	27
Proteus (1)	1	0	0
Gram positive+gram negative-4
SV+KP (2)	2	0	18
SV+PS (1)	0	1	19
SV+PS+KP (1)	0	1	0
Anaerobes-2
Gram positive
Propionibacterium acnes (1)	1	0	0
Gram negative
Bacteroides fragilis (1)	1	0	110
Mycobacterium-1
Tuberculosis (1)	0	1	111
Fungus-1
Cryptococcus neoformans (1)	0	1	112
Sterile culture-9	6	3	113

¹Brain: 1; liver: 1.

²lung: 1; retroperitoneum: 1; brain: 1.

³retroperitoneum: 1.

⁴liver: 1; subphrenic area: 1; gluteal muscle: 1; pancreas: 1.

⁵liver: 4; brain+lung: 2; subphrenic area: 1.

⁶anus: 1.

⁷aortic valve: 1; subphrenic area: 1.

⁸subphrenic area: 1.

⁹gluteal muscle (1).

¹⁰pancreas: 1.

¹¹liver: 1.

¹²liver: 1.

¹³pancreas: 1.

Table 4 Locations of extrasplenic abscesses

Location	Case number (%)
Liver	9 (34.6)
Subphrenic area	4 (15.4)
Pancreas	3 (11.5)
Brain	3 (11.5)1
Lung	3 (11.5)1
Retroperitoneal cavity	2 (7.7)
Gluteal muscle	2 (7.7)
Aortic valve	1 (3.85)
Anus	1 (3.85)

¹Twenty-six patients had single, and two patients had two sites of extrasplenic abscesses (lung+brain).

Table 5 Prognostic factors of splenic abscess

Variables	Category (n)	Outcome		P
		Cure(n = 55, %)	Mortality (n =12, %)
Gender	Female (26)	21 (81)	5 (19)	NS1
	Male (41)	34 (83)	7 (17)
Abscess number*	Solitary (48)	43 (89)	5 (11)	0.0111
	Multiple (19)	12 (63)	7 (37)
Extrasplenic abscesses	Without (43)	36 (84)	7 (16)	NS1
	With (24)	19 (79)	5 (21)
Underlying diseases	Without (15)	12 (80)	3 (20)	NS1
	With (52)	43 (83)	9 (17)
Diabetes	Without (41)	33 (80)	8 (20)	NS1
	With (26)	22 (85)	4 (15)
Microorganisma
	GNB (32)	22 (69)	10 (31)	0.0091a
	GPC (18)	18 (100)	0 (0)
	GNB+GPC (4)	4 (100)	0 (0)
	Others (4)	2 (50)	2 (50)
	Sterile (9)	9 (100)	0 (0)
Treatment	Splenectomy (26)	24 (92)	2 (8)	NS1
	PD or FNA+AT (21)	15 (71)	6 (29)
	AT alone (20)	16 (80)	4 (20)
Age		53.3 ± 13.4	57.3 ± 17.1	NS2
Size of abscess2		5.1 ± 3.0	4.0 ± 2.6	NS2
Leukocytes/mm3		13.1 ± 4.5	9.6 ± 5.9	NS2
APACHE II score*		7.3 ± 3.8	16.1 ± 3.2	<0.0012

GNB, gram negative bacillus; GPC, gram positive cocci; PD, percutaneous drainage; FNA, fine needle aspiration; AT, antimicrobial therapy. Categorical data were compared by: 1: χ² test or F-test, 2: t-test.

^aP<0.05 GNB vs GPC. NS: not significant.