Clinical, Laboratory, and Management Profile in Patients of Liver Abscess from Northern India

Abstract

Objective. To describe the clinical profile, microbiological aetiologies, and management outcomes in patients with liver abscess. Methods. A cross-sectional study was conducted from May, 2011, to April, 2013, on 200 consecutive liver abscess patients at PGIMER and Dr. RML Hospital, New Delhi. History, examination, and laboratory investigations were recorded. Ultrasound guided aspiration was done and samples were investigated. Chi-square test and multivariate regression analysis were performed to test association. Results. The mean age of patients was 41.13 years. Majority of them were from lower socioeconomic class (67.5%) and alcoholic (72%). The abscesses were predominantly in right lobe (71%) and solitary (65%). Etiology of abscess was 69% amoebic, 18% pyogenic, 7.5% tubercular, 4% mixed, and 1.5% fungal. Percutaneous needle aspiration was done in 79%, pigtail drainage in 17%, and surgical intervention for rupture in 4% patients. Mortality was 2.5%, all reported in surgical group. Solitary abscesses were amoebic and tubercular whereas multiple abscesses were pyogenic (P = 0.001). Right lobe was predominantly involved in amoebic and pyogenic abscesses while in tubercular abscesses left lobe involvement was predominant (P = 0.001). Conclusions. The commonest presentation was young male, alcoholic of low socioeconomic class having right lobe solitary amoebic liver abscess. Appropriate use of minimally invasive drainage techniques reduces mortality.

Clinical and biochemical profile of liver abscess patients

“…7 In present study also ALA accounted for more than three-fourth of cases, most of them being solitary right lobe abscess. This pattern of involvement has also been reported in previous series on ALA by Sharma et al, Mukhopadhyay et al and Ghosh et al [9][10][11] The mean age of patients in our study was 41.8 years which was in accordance with Indian studies, Ghosh et al, Sharma et al and Mukhopadhyay et al who reported it to be 41, 40.5 and 43.64 years, respectively. 9-11 Highest incidence of liver abscess was seen in fifth decade of life with similar finding in ALA cases but PLA was present in all age groups in equal frequency.…”

“…It was seen in 26% of patients by Ghosh et al 11 In earlier studies from India, it was reported in 45-50% of patients. 18 But after advent of good antimicrobial therapy, it has become less common.…”

“…Ghosh et al reported it to be present in 99% and 94% whereas various other studies quote it in range of 62-94% and 67-87%, respectively. [9][10][11] Nausea and anorexia were other significant symptoms present in 48% and 50% patients respectively with greater frequency in ALA. Ghosh et al in their study reported 93% patients with anorexia and 54% with nausea and vomiting. 11 Cough was another uncommon symptom which was present in 22% patients.…”

“…15 Ghosh et al had 72% alcoholic patients in their study. 11 Alcohol suppresses function of Kupffer cells (specialized macrophage) in liver which has important role in clearing amoeba. Moreover, invasive amoebiasis appears to be dependent on the availability of free iron.…”

A prospective study of ultra-sonographic and radiological profile of patients with liver abscess

“…8 Siddiqui et al reported that according to USG report 70% patients were having single abscess and the rest 30% had multiple abscesses. 6 This pattern of involvement has also been reported in previous series on ALA by Sharma et al, Mukhopadhyay et al and Ghosh et al [10][11][12] In present study, chest X-ray abnormality was more in PLA (50%) compared to ALA group (35.8%). Reports of Choudhary et al reported that chest X-ray finding were abnormal in 39% of cases and was comparable to present study findings.…”