CLINICAL, BIOCHEMICAL, AND IMAGE CHARACTERISTICS IN PATIENTS WITH A DIAGNOSIS OF AMEBIC AND BACTERIAL LIVER ABSCESS.

Introduction and Objectives

A hepatic abscess (HA) accumulates purulent material in the liver parenchyma and can be of bacterial, parasitic, fungal, or mixed origin. The incidence ranges from 2.3 to 22 per 100,000 people. In Mexico, the annual incidence of amoebic liver abscess is 6.7 per 100,000 population.

IAM

To determine the clinical, biochemical, and imaging characteristics in patients diagnosed with amoebic and bacterial liver abscess.

Materials and Methods

Research design: Descriptive, cross-sectional/prevalence.

Procedure

We analyzed medical records of patients admitted during 2019 with a diagnosis of liver abscess and who had an amoeba PCR test. The qualitative variables were expressed in frequencies and percentages; the numerical variables were mean and standard deviation. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate.

Results

Of a total of 32 patients admitted with a liver abscess in Gastroenterology during 2019, 20 patients treated with drainage and PCR test for amoeba of the abscess fluid were included. Of these, 85%(17) were men with a mean age of 45.35±10.93 years, and 55%(11) were of bacterial etiology. Regarding the characteristics due to their etiology (amoebic vs. bacterial): 30%(6) were presented in segments VII and VIII; [33.3%(2/6) amoebic vs. 66.7%(4/6) bacterial]. According to the number, they were multiple; 28.6%(2/7) amoebic vs 71.4%(5/7) bacterial, unique; 53.8%(7/13) amoebic vs 46.2%(6/13) bacterial, without significant difference (p = 0.37). 60%(12) presented with pleural effusion, and of these, 58.3%(7) were amoebic. 100% were drained, of which 50% were by catheter with a diameter of 14Fr. Regarding the laboratory studies: 80%(16) of those with amoebic etiology had cultures of the abscess fluid without development, the leukocytes were 18.65 ± 6.55mm3 with a range of 16.5 in the amoebians vs. 14.58±6.51mm3 with a range of 17.6 in bacteria, Hb of 12.10±1.93 gr/dl in amoebians vs. 12.18 ± 1.72 gr/dl in bacteria and with procalcitonin of 18.06±12.77 gr/dl in amoebic vs. 19.98±59.76 gr/dl in bacterial. According to the imaging studies: the USG diameter was 10.67±2.78cm in amoebians vs. 10.53±4.91cm in bacteria and with a volume of 375.08±263.95 with a range of 782.0cm3 in amebic vs. 441.80±393.90 with a range of 1362.1cm3 in bacterial.

Discussion

Common etiologic agents for HA are E. histolytica (amoebic), bacterial (pyogenic), Mycobacterium tuberculosis, and various fungi. They tend to affect the younger population, especially men with immunosuppression, diabetes, and alcohol consumption. In developing countries, two-thirds are of amoebic origin and in need of puncture drainage. Our study observed that half had amoebic etiology corroborated by amoeba PCR, the majority unique, and almost all required drainage with diameters greater than 5cm by USG.

Conclusions

In the present work, we can show that half of the patients diagnosed with a liver abscess in the Gastroenterology Service are of amoebic origin and have similar characteristics to those described in the international bibliography.

The authors declare that there is no conflict of interest.