Liver abscess: demographic, clinical, biochemical, imaging and microbial spectrum
Keywords:Amoebic, Liver abscess, Microbial, Pyogenic
Background: Liver abscesses are localized suppurative destruction of liver tissue due to infections of either bacterial (Pyogenic) or protozoa (Amoebic). Historically; pyogenic liver abscess has been described since the time of hippocrates (400 BC). Despite the more aggressive approach to treatment, the mortality rate remained at 60-80%.
Methods: This Cross-sectional analytical study carried out at Department of Medicine, Al-Tibri Medical College Hospital, Karachi, from June 2017 to December 2018. All participants of either gender with diagnosis of liver abscess were included in this prospective study. Patients with co morbidities like malignancy, autoimmune disease or on immunosuppressive treatment for any reason were excluded from the study. Following confirmation of the diagnosis; different characteristics of either type of liver abscess like demographic, clinical features, biochemical and imaging findings were evaluated.
Results: Data of 73 subjects, 65(89.0%) males and 08(11.0%) females were analyzed with mean age was 45.42±14.518 years. Fifty-four (73.97%) patients had pyogenic liver abscess while amoebic liver abscess was found in 19(26.03%) subjects. Clinically, the most common symptom was abdominal pain, found in 66(90.4%) subjects, followed by fever in 61(83.6%), hepatomegaly in 47(64.4%), jaundice in 18(24.7%) and vomiting in 10(13.7%) cases. Demographics and clinical features are shown in (Table 1).
Conclusions: Local trends have been changing and majority of liver abscess were of pyogenic liver abscesses. Clinically, clear differentiation between two types of abscesses is not possible always but few manifestations like typical symptoms, raised alkaline phosphatase and leucocytosis may be helpful.
Ochsner A, DeBakey M, Murray S. Pyogenic abscess of the liver: II. An analysis of forty-seven cases with review of the literature. Am J Surg. 1938 Apr 1;40(1):292-319.
Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clini Gastroenterol Hepatol. 2004 Nov 1;2(11):1032-8.
Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Inf Dis. 2008 Oct;14(10):1592.
Lai SW, Lai HC, Lin CL, Liao KF. Splenectomy correlates with increased risk of pyogenic liver abscess: a nationwide cohort study in Taiwan. J Epidemiol. 2015 Sep 5;25(9):561-6.
Liao KF, Lin CL, Lai SW, Chen WC. Zolpidem use associated with increased risk of pyogenic liver abscess: a case-control study in Taiwan. Medicine. 2015 Aug;94(32).
Mei-Ling S, Kuan-Fu L, Sung-Mao T, Cheng-Li LM, Shih-Wei L. Herpes zoster correlates with pyogenic liver abscesses in Taiwan. Biomed. 2016 Dec;6(4).
Malik AA, Bari SU, Rouf KA, Wani KA. Pyogenic liver abscess: Changing patterns in approach. World J Gastro Surg. 2010 Dec 27;2(12):395.
Kuo SH, Lee YT, Li CR, Tseng CJ, Chao WN, Wang PH, et al. Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess. Am J Emerg Med. 2013 Jun 1;31(6):916-21.
Huang CJ, Pitt HA, Lipsett PA, Osterman Jr FA, Lillemoe KD, Cameron JL, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Annal Surg. 1996 May;223(5):600.
World Health Organization. Amoebiasis. Weekly Epidemiol Rec. 1997:72: 97-100.
Fernando K, Fernando R, Kandasami A, Jude R, Fernando N, Tennakoon S. SP6-3 Fermented sap of spiky Palmyra toddy (Borassus flabellifer) suggested as a vehicle of transportation of amoebiasis in the district of Mannar, Sri Lanka: 50 cases of amoebic liver abscess within 15 months. J Epidemiol Comm Health. 2011 Aug 1;65(1):A455.
Kannathasan S, Iddawala WMDR, Silva NR De, Haque R: Knowledge, attitude and practice towards liver abscess among patients admitted to the teaching hospitals, Jaffna. Proc Peradeniya Univ Int Res. 2014;18:355.
Kannathasan S, Murugananthan A, Kumanan T, Iddawala D, de Silva NR, Rajeshkannan N, et al. Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology. Parasites Vectors. 2017 Dec;10(1):14.
Aikat BK, Bhusnurmath SR, Pal AK, Chhuttani PN, Datta DV. The pathology and pathogenesis of fatal hepatic amoebiasis a study based on 79 autopsy cases. Transactions Royal Soc Tropical Med Hygiene. 1979 Jan 1;73(2):188-92.
Kong H, Yu F, Zhang W, Li X. Clinical and microbiological characteristics of pyogenic liver abscess in a tertiary hospital in East China. Med. 2017 Sep;96(37).
Tirkey AS, Jain M. Study of clinical, etiological, and biochemical profile of patients with liver abscess: A prospective study. Int J Med Sci Pub Health. 2018 Nov 1;7(11):905-9.
Zhu X, Wang S, Jacob R, Fan Z, Zhang F, Ji G. A 10-year retrospective analysis of clinical profiles, laboratory characteristics and management of pyogenic liver abscesses in a Chinese hospital. Gut Liver. 2011 Jun;5(2):221.
Baig A, Ishaq M, Kumar A, Sheikh MI. Pyogenic liver abscess: A five year retrospective study in slums of Karachi. JLUMHS. 2012 Jan;11(01):19.
Chen YC, Lin CH, Chang SN, Shi ZY. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000-2011. J Microbiol, Immunol Infect. 2016 Oct 1;49(5):646-53.
Ahsan T, Jehangir MU, Mahmood T, Ahmed N, Saleem M, Shahid M, et al. Amoebic versus pyogenic liver abscess. J Pak Med Assoc. 2002 Nov;52(11):497-501.
Tian LT, Yao K, Zhang XY, Zhang ZD, Liang YJ, Yin DL, et al. Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China. Clin Microbiol Infect. 2012 Sep 1;18(9):E314-30.
Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA. Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. Trop Med Int Health. 2004 Jun;9(6):718-23.
Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, et al. Characteristics and management of pyogenic liver abscess: A European experience. Med. 2018 May;97(19).
Lin YT, Wang FD, Wu PF, Fung CP. Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics. BMC Inf Dis. 2013 Dec;13(1):56.
Kim JK, Chung DR, Wie SH, Yoo JH, Park SW, Korean Study Group for Liver Abscess. Risk factor analysis of invasive liver abscess caused by the K1 serotype Klebsiella pneumoniae. Eur J Clini Microbiol Infect Dis. 2009 Jan 1;28(1):109.
Chan DS, Archuleta S, Llorin RM, Lye DC, Fisher D. Standardized outpatient management of Klebsiella pneumoniae liver abscesses. Int J Infect Dis. 2013 Mar 1;17(3):e185-8.