A 60-Year Literature Review on Hepatic Actinomycosis

Abstract

Hepatic actinomycosis (HA) is a rare infection with indolent course, atypical clinical manifestations, nonspecific laboratory and imaging findings and challenging diagnosis. We describe a case of a 35-y-old female who developed HA 2 weeks after gastrectomy. In addition, we analyzed clinical characteristics and outcome of 157 additional cases of HA identified in a 60 years’ literature review. Patients with HA were predominantly male (57%) and more than one-half were between 40 and 70 years of age. Of interest, the infection was cryptogenic in 80.8% of cases. Risk factors for HA were identified in 63.1% of the patients. Clinical presentation included fever (57.7 %), abdominal pain (52.1%), weight loss (45.1%), anorexia (27.5%), fatigue and chills (12.7% each), and malaise (12%) over a 2.35±3.5 months period. Leucocytosis, elevated alkaline phosphatase, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the most frequent laboratory findings. Radiologic imaging revealed that the right lobe was more frequently affected (62.5%) with a single lesion found in two-thirds of cases. Diagnosis was achieved by histopathologic examination in 70.6% of cases. Cultures yielded Actinomyces in 45 instances, with A. israelii being the most frequent species. Less than one half of the patients were treated only with antibiotics, while the others received combined medical and surgical treatment. The median duration of antibiotic therapy was 135 days (range: 7-730 days). The presence of multiple lesions or solid tumor like lesions was significantly associated with medical therapy alone. The outcome was favorable in most cases (94%). Although rarely encountered, HA should be considered in patients with a chronic or subacute inflammatory process of the liver, in order to promptly diagnose and treat.

The investigating of clinical and radiological findings of hepatic actinomycosis

“…In the laboratory, increased leukocytes (75%), high erythrocyte sedimentation rate, and alkaline phosphatase (83.3%) are observed. CA 19.9 values may be slightly elevated [5,7].…”

“…The main risk factors are loss of integrity of the gastrointestinal mucosa, intra-abdominal infection, previous abdominal surgery, immunosuppression, and presence of a foreign body. The involvement of the liver occurs by hematogenous spread through the portal vein from infection or mucosal injury [1,5,6].…”

“…Despite advanced imaging techniques, the preoperative diagnosis rate is less than 10%. The blood cultures are positive in only 15% of cases, and the diagnosis of percutaneous biopsy is not always certain [2,5,13]. Current therapeutic options are antibiotics, percutaneous drainage, or surgical resection.…”

“…They were mostly low-intensity changes making them easily misdiagnosed as metastatic cancer and primary liver cancer. Acute bacterial abscess-like changes and cystic mass-like changes were seen in a few cases [5]. In this study, we investigated the clinical features, common radiological findings, and diagnosis of HA.…”

Nichtvirale Infektionen der Leber

“…Eine Leberbeteiligung ist selten und wird bei etwa 15 % der abdominalen Infektionen beobachtet. Die hepatische Aktinomykose betrifft etwas häufiger immunkompetente Männer mit einem mittleren Alter von 49 Jahren [ 9 ]. Häufigste Symptome sind Fieber (57,7 %), gefolgt von Abdominalschmerzen (52,1 %), Gewichtsverlust (45,1 %), Anorexie (27,5 %) und Schüttelfrost (12,7 %).…”