화농성 및 아메바 간농양 - kasl.org

1 21 Pyogenic and Amebic Liver Abscess Pyogenic and amebic liver abscesses are the two most common hepatic abscesses. Amebic abscesses are more common in areas where Entamoeba histolytica is endemic, whereas pyogenic abscesses are more common in developed countries that mainly caused by Klebsiella pneumoniae. Pyogenic abscess severity is dependent on the bacterial source and the underlying condition of the patient. Amebic liver abscess is more prevalent in individuals with suppressed cell-mediated immunity, men, and younger people. The right lobe of the liver is the most likely site of infection in both types of hepatic abscess. Patients usually present with a combination of fever, right-upper-quadrant abdominal pain, and hepatomegaly.

2 Jaundice is more common in the pyogenic abscess. The diagnosis is often delayed and is usually made through a combination of radiologic imaging and microbiologic, serologic, and percutaneous techniques. Treatment involves antibiotics along with percutaneous drainage or words:Liver abscess, Pyogenic, Liver abscess, Amebic , , , . , . , , , , AIDS.

3 2012 Single Topic Symposium22 , , , . , 48% .1 55-60 , , .2-3 , 50.

4 , .4,5 1) , , . 1970 Staphylococcus Escherichia coli 1980 staphylococcus 1980 klebsiella pneumoniae 2000 E. coli Bacteroides fragilis . K. pneumoninae (78%), (10 %), Streptococcus ( ), Enterococcus (5%), Citrobacter ( ), Staphylococcus (1%) K. pnumoniae .6-8 Pyogenic and Amebic Liver Abscess232) Klebsiella pneumoniae liver abscessK.

5 Pneumoniae , , , , (endophthalmitis) . 1990 .9 K. pneumoniae 77 K1 . 95% K1 serotype K. pneumoniae .6,7K. pneunmoniae Klebsiella . K. pneumoniae , Kupffer K. pneumoniae . K. pneumoniae.

6 50% K. pneumonae 95% . , , , , , , . 8-10% K. pneumoniae .K. pneumoniae ampicillin, metronoidazole piperacillin, 3 cephalosporin, ciprofloxacin . gen-tamicin aminoglycoside . 2-3 IV ..103) Intervention related abscess.

7 , 2012 Single Topic Symposium24 .. 50-90% . , , CRP , , .114) Cancer and abscess 5-42% . 11-80% . APACHE II , , . , . K. pneumoniae bacteroides.

8 12 . , , .. , . C- , . , . 85-95% , .. Pyogenic and Amebic Liver Abscess25 . , , 25-35% .13.

9 , .. 1938 Ochsner DeBakey 1980 .14,15 5 cm , 1 . 5 cm .16 , , . 5 cm , , , . 2-3 , 3.

10 , 4-6 . 2 .17 75-80% , 6-32% .18 Entameoba histolytica , . 4-5 , , .19,20 2012 Single Topic Symposium26 20-40.