Liver abscess in children: A 10-year single centre experience

Abstract

Background/Aim:Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries.Materials and Methods:The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients’ records retrospectively.Results:There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscesswere immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later ttaken for open drainage, with an overall mortality rate of 5.5%. Conclusion: The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.

Liver Abscess in Children

“…5,6,[8][9][10] The average age range of affected children is between 3 and 8 years, although PLA can occur in older children as well. 2,[4][5][6]9,11 Mortality from PLA ranges from 5 to 15% and is largely due to uncontrolled and overwhelming sepsis. 2,5,[10][11][12] An estimated 500 million people worldwide are carriers of amebiasis, which results in 40,000 to 100,000 deaths annually, making it the second leading cause of death from parasitic disease worldwide after malaria.…”

“…2,[4][5][6]9,11 Mortality from PLA ranges from 5 to 15% and is largely due to uncontrolled and overwhelming sepsis. 2,5,[10][11][12] An estimated 500 million people worldwide are carriers of amebiasis, which results in 40,000 to 100,000 deaths annually, making it the second leading cause of death from parasitic disease worldwide after malaria. 3,13 In children, death due to amebiasis is usually related to amoebic dysentery rather than amebic liver abscess (ALA), which is relatively uncommon.…”

A Case of Pyogenic Liver Abscess Caused by Staphylococcus epidermidis in a Healthy Child

“…Pyogenic liver abscess is rare in children living in developed countries, but relatively common in developing countries, especially in tropical climates 9,10) . The incidence varies from 25 per 100,000 admissions in the USA 6) , and 11 per 100,000 admissions in Denmark 7) , to 1 per 140 admissions in Brazil 8) , and more than 79 per 100,000 admissions in India 9) . In Korea, reports on children with pyogenic liver abscess due to Staphylococcus aureus 1) and Streptococcus 2) have been published.…”

Law and force

“…Circuit has clarified that " [e]vidence that an individual operated within al-Qaida's command structure is 'sufficient but is not necessary to show he is 'part of' the organization'" for purposes of detention. 161 As noted above, the United States has also interpreted the 2001 AUMF to authorize the detention of individuals who "substantially support" enemy forces in the course of their hostilities against the United States or its coalition partners. This interpretation is informed by the law of armed conflict governing international armed conflicts, which allows for the detention of a narrow category of individuals who are not part of the enemy but bear sufficiently close ties to those forces as to be detainable.…”