Splenic Abscess

PATHOGENS

• Polymicrobial in up to 25%, including anaerobes.
  • Given that most splenic abscesses are secondary to bacteremia or fungemia (e.g., associated with endocarditis, UTI, pancreatitis, GI tract, etc.), the likely pathogen(s) are determined by the original focus.
• Gram-negative bacilli, especially E. coli, Salmonella spp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Serratia marcescens
• Gram-positive bacteria: Staphylococcus aureus, Streptococci, Enterococci
• Anaerobes: Peptostreptococci and microaerophilic streptococci, Clostridium spp, Fusobacterium spp, Bacteroides spp, Prevotella spp, Cutibacterium spp (ex Propionibacterium)
• Candida spp.
  • Neutropenia and chronic corticosteroid use predispose to candidal splenic abscesses.
  • Chronic disseminated candidiasis (formerly hepatosplenic candidiasis) often includes frank candidal splenic abscesses.
• Mycobacteria
  • Tuberculosis
• Rare:
  • Burkholderia pseudomallei, Brucella spp, Bartonella, Coxiella burnetii, Actinomycetes,Plasmodium vivax
  • Aseptic abscesses have been described in association with Behçet’s disease.