Klebsiella Pneumoniae Liver Abscess in Childhood - A Case Report

孩童肺炎桿菌肝膿腫－一病例報告

劉秋聯(Kiew-Lian Liew) ； 鍾全生(Choun-Seng Choong) ； 劉保寧(Pao-Ning Liu) ； 蔡東烜(Dong-Hsuan Tsai) ； 黃永豐(Yung-Feng Huang) ； 邱寶琴(Pao-Chin Chiu) ； 謝凱生(Kai-Sheng Hsieh)

《慈濟醫學雜誌》 10卷3期 (1998/09) Pp. 247-252

https://doi.org/10.6440/TZUCMJ.199809.0247

摘要

孩童化膿性肝膿腫(pyogenic liver abscess)並不常見；特別是原因不明(cyptogenic)之化膿性肝膿腫。在小孩的族群中，大部份化膿性肝膿腫所分離出來的菌種是金黃色葡萄球菌(Staphylococcu aureus)；而革蘭陰性桿菌(Gram negative bacilli)則相對少見。故孩童之肺炎桿菌肝膿腫便是一種十分罕見的病症。於此，我們將報告一個十一歲健康的孩童，患化膿性肝膿腫之病例。病童沒有特異(specific)的臨床主訴和症狀；腹部超音波發現了該肝膿腫。檢查發現病童的肝膿腫的抽取液和靜脈血液，均培養出胞炎桿菌(Klebsiella pneumoniae)。該病童成功的接受抗生素(cefazolin 100 mg/kg/day和gentamicin 4 mg/kg/day)、經皮穿肝抽吸和pig-tail引流治療後，將此病症治癒。病童共住院了18天。其間病童沒有使用外科處置治療，也沒發生細菌性移行性病灶(septic metastatic lesion)。

關鍵字

肝膿腫 ； 肺炎桿菌 ； 孩童 ； 超音波 ； pig-tail引流

並列摘要

A pyogenic liver abscess, especially cryptogenic one, is rarely seen in children. The most common isolate in liver abscesses in the pediatric population is Stsphylococcus aureus while gram negative bacilli are relatively rare. A Klebsiella pneumoniae liver abscess in childhood is unusual. Herein, we report on an eleven-year-old healthy boy who had a pyogenic liver abscess. We found the abscess on abdominal sonographic examination without any specific signs and symptoms. Klebsiella pneumoniae was cultured from the liver abscess and the patient’s blood stream. The disease was cured with antbi-otics (cefazolin 100 mg/kg/day and gentamicin 4 mg/kg/day), percutaneous transhepatic aspiration and pig-tail drainage without any surgical intervention. No septic metastatic lesions were found during hospitalization and the patient was discharged to follow-up after 18 days.

並列關鍵字

liver abscess ； klebsiella pneumoniae ； childhood ； sonography ； pig-tail drainage