Hepatic abscess and hydatid liver cyst: European infectious disease point of view

Abstract

This manuscript is based on a recent study by Pillay et al that was published in recently. Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin. The incidence rate in Europe is lower than in developing countries, but it is a major complication with high morbidity, particularly in immunocompromised patients. They are most frequently caused by Enterobacterales infections, but hypervirulent Klebsiella strains are an emerging problem in Western countries. Amoebiasis has been a public health problem in Europe, primarily imported from other endemic foci. At the same time, this infection is becoming an emerging disease, as the number of infected patients who have not traveled to endemic areas is rising. Treatment options for hydatid liver cyst include chemotherapy, open or laparoscopic surgery, percutaneous treatment (percutaneous aspiration, re-aspiration and injection and its modification) and ‘‘wait and watch’’ strategy. Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment, but several studies have confirmed the safety and efficacy of percutaneous aspiration, re-aspiration and injection.

Keywords: Hepatic abscess; Liver cystic echinococcosis; Ultrasound-guided intervention; Klebsiella pneumoniae; Percutaneous aspiration; Amoebic liver abscess; Hypervirulent pathogens

Core Tip: Pyogenic and amoebic liver abscess represent a significant challenge in the diagnosis and treatment of focal bacterial and parasitic infectious hepatic disease, even in European countries. Ultrasound (US) is the first and main imaging tool involved in the diagnosis of these two rare and neglected diseases, respectively. US and US-guided percutaneous drainage of hepatic abscesses, either pyogenic or amoebic, play an essential role in their management. In hydatid liver cyst percutaneous puncture, injection of scolicidal agent with or without reaspiration has been shown to have higher efficacy, fewer complications and hospital stay compared to surgery.