Pillay K, Khan ZA, Nweke EE, Omoshoro-Jones J. Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals. World J Hepatol 2024; 16(12): 1417-1428 [DOI: 10.4254/wjh.v16.i12.1417]
Corresponding Author of This Article
Krevosha Pillay, MBChB, MMed, Lecturer, Surgeon, Department of Surgery, University of Witwatersrand, School of Clinical Medicine, 7 York Road, Johannesburg 2193, Gauteng, South Africa. krevoshap@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2024; 16(12): 1417-1428 Published online Dec 27, 2024. doi: 10.4254/wjh.v16.i12.1417
Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals
Krevosha Pillay, Zafar Ahmed Khan, Ekene Emmanuel Nweke, Jones Omoshoro-Jones
Krevosha Pillay, Zafar Ahmed Khan, Ekene Emmanuel Nweke, Jones Omoshoro-Jones, Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
Zafar Ahmed Khan, Jones Omoshoro-Jones, Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
Author contributions: Omoshoro-Jones J and Pillay K contributed to study design; Pillay K and Khan ZA contributed to data acquisition and analysis; Pillay K drafted the manuscript; Omoshoro-Jones J, Khan ZA, and Nweke EE contributed to manuscript review and revision.
Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of the University of Witwatersrand.
Informed consent statement: This was a retrospective review of an administrative database, thus informed consent was not obtained.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Krevosha Pillay, MBChB, MMed, Lecturer, Surgeon, Department of Surgery, University of Witwatersrand, School of Clinical Medicine, 7 York Road, Johannesburg 2193, Gauteng, South Africa. krevoshap@gmail.com
Received: April 17, 2024 Revised: October 2, 2024 Accepted: October 29, 2024 Published online: December 27, 2024 Processing time: 225 Days and 20.3 Hours
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.
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.
