Liver Abscess in Children-experience From a Single Tertiary Care Center of North India

Abstract

Background: Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children. Methods:The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications. Results: ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days. Conclusions: ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/ international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA.

Pediatric Liver Abscess: Outcomes of Protocol-based Management and Predictors of Poor Outcome

“…15,25 Hyperbilirubinemia was found in 12.5% of our patients in consistence with 14.8%–18.3% in 2 other Indian studies with larger cohorts of pediatric LA. 15,25 Other studies reporting higher incidences of hyperbilirubinemia (25.3%–42.9%) had smaller cohorts and a larger proportion of noncryptogenic LAs. 13,24 Jaundice in LA may occur due to sepsis, hepatocellular dysfunction, intrahepatic biliary obstruction by expanding abscess and bilio-vascular fistula.…”

“…In 2 other large studies, nearly three-fourths of patients had a raised prothrombin time indicating liver dysfunction. 15,25 Hyperbilirubinemia was found in 12.5% of our patients in consistence with 14.8%–18.3% in 2 other Indian studies with larger cohorts of pediatric LA. 15,25 Other studies reporting higher incidences of hyperbilirubinemia (25.3%–42.9%) had smaller cohorts and a larger proportion of noncryptogenic LAs.…”

“…The commonest laboratory findings in our study included anemia (96.6%) and leukocytosis (59.1%) in concurrence with previous literature where anemia has been reported in 81.6%-89.6% patients and leukocytosis in 64.9%-73.5%. 6,12,13,15,24,25 Nearly 58.7% children had microcytic hypochromic anemia which could be explained by a good proportion of children in this cohort being undernourished, possibly associated with unrecognized worm infestation on a background of a high prevalence of iron deficiency anemia in children India. A good proportion of children also had normocytic normochromic anemia which could be due to the chronic inflammation caused by a delayed presentation or diagnosis of liver abscess.…”

“…Few other pediatric studies have identified predictors of poor outcomes including larger size of abscess, neutrophilia, 7 elevated alkaline phosphatase, 6 prolonged prothrombin time and hypoalbuminemia. 25 It is imperative to identify predictors of poor outcomes in children with LA to lay appropriate clinic-radiological monitoring and management guidelines.…”

Burden of parasitic infection and its impact on growth of children with hepatitis C Virus

“…Parasitic (helminths and protozoal) infections may lead to variety of medical problems such as irritable bowel syndrome, chronic fatigue syndrome, food allergies, colic, anorexia, abdominal distension, anxiety and reactive arthritis 12 , iron-deficiency anemia, malnutrition, growth failure and disturbance of cognitive functions 13 . Moreover, many of the helminths and protozoa may reach the liver causing direct hepatic tissue injury, inflammation and abscess formation [14][15][16] . The aim of the study is to assess the impact of different protozoa and helminthes infection on growth of children with hepatitis C virus infection.…”