Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals

Abstract

BACKGROUND

Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries.

AIM

To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.

METHODS

Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed.

RESULTS

In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group (P < 0.0002 and P < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% (n = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% (n = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%.

CONCLUSION

In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.

Keywords: Amoebic liver abscess; Hydatid liver disease; Liver Echinococcosis; Human Immunodeficiency Virus; Pyogenic liver abscess; Percutaneous drainage

Core Tip: The incidence, etiology, and microbiology of liver abscesses vary across geographical areas. There is a paucity of published data evaluating liver abscesses and hydatid liver disease in Sub Saharan Africa. HIV and diabetes mellitus were major comorbidities, highlighting immunosuppression as an important factor in the pathogenesis of infective liver collections. The majority of patients were managed non-operatively, with surgery reserved for complications. The small number of hydatid disease cases in this study made it difficult to draw significant conclusions in this group of patients, and further prospective studies are required.