Clinicopathological presentation of liver abscesses at two Johannesburg Academic Hospitals

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Background: Hepatic abscesses represent infection of the liver parenchyma from bacteria, fungi and parasitic organisms. Trends in both the microbiology and management of these have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in South Africa and Africa. Aims: To evaluate the demographic, clinical, radiological and laboratory presentations of liver abscesses at two University of Witwatersrand referral institutions. Methods: Review and analysis of information accessed from electronic discharge summaries (EDS) of patients from two hepatopancreatobiliary (HPB) tertiary units in Gauteng, from January 2016 to December 2020. All patients older than 13 years, presenting with liver abscesses: pyogenic, amoebic and hydatid, were included. Clinical findings, laboratory, microbiology and radiology results were collated and analysed. Results: There were 222 patients: 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. HIV (24.23%), hypertension (20.57%) and diabetes mellitus (16.83%) were the main comorbidities observed. The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant aetiology of the pyogenic liver abscesses (PLA) was biliary. White cell count (WCC) and CRP were significantly higher in the pyogenic group (p <0.0002 and p<0.007, respectively) as compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood (17.58%) and abscess fluid (56.6%). Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. Seventysix percent of patients requiring drainage had a percutaneous drain placed, while 8.76% required open surgery. The median length of hospital stay was 13 days. There was a mortality rate of 3.02%. Conclusions: In this study, the commonest type of liver abscess was PLAs in middle-aged males. The microbiology was similar to Asian populations and non-surgical management via percutaneous drainage was sufficient in the majority of cases. Uniquely, HIV occurred in about one-quarter of the group and was significantly higher in the amoebic and hydatid groups. vii Whilst this did not impact outcomes, further prospective studies are required to ascertain the impact of HIV in these patients.
A research report submitted in partial fulfilment of the requirement for the degree of Master of Medicine (MMed) in Surgery to the Faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2023
Amoebic liver abscess, Hydatid liver disease, Liver echinococcosis, Pyogenic liver abscess, Percutaneous drainage