Liver abscesses in the Western pediatric population

Abstract

Background and study aims: Liver abscesses are rare in the Western pediatric population and data on predisposing factors and etiology are scarce. We aimed to describe predisposing factors, microbiological characteristics, and treatment. Patients and methods: Retrospective analysis of children admitted to two tertiary care hospitals in Belgium from 1 January 1996 to 31 December 2019. We analyzed clinical features, predisposing factors, imaging characteristics, microbiological data, treatment, and outcome in children with a liver abscess and compared these data with the literature. Results: We collected 24 cases with a male to female ratio of 1.4 and a median age of 3.2 years at time of diagnosis. Survival was 95.8%. Invasive culture specimens were obtained in 83.3% and showed growth of bacteria in 55%. Parenteral antibiotics were administered before invasive culture sampling in 80%. Liver abscesses were cryptogenic in four (16.7%) patients. Hepatobiliary disease was the most prevalent predisposing factor (n = 6; 25%), followed by recent antineoplastic therapy for malignancies (n = 5; 20.8%), intra-abdominal surgical pathology (n = 4; 16.7%) and umbilical venous catheters (n = 2; 8.3%). In two patients there was a parasitic origin (n = 2; 8.3%) and in one it was caused by Bartonellosis. There was no diagnosis of chronic granulomatous disease (CGD) in our cohort. Conclusions: Pediatric liver abscesses have a favorable outcome in the developed world. Whenever feasible, invasive abscess culture specimens should be obtained. In patients presenting with a cryptogenic liver abscess or atypical disease course, immunological workup should be ensured.

Respiratory Symptoms are the First Presentation of Liver Abscess

“…The low sensitivity of blood culture is also indicated in previous reports. 1,4 Although severe LAs are known to be associated with chronic granulomatous disease, 5 this patient showed no signs of inborn errors of immunity.…”

Essential reading from the editor’s desk

“…However, to ensure safe and effective drainage, some degree of wall maturation is awaited in most cases, although the timing of sufficient maturation is still controversial. In their retrospective series, Choudhury et al demonstrated full encapsulation in 56% of cases at 4 weeks, validating the suggestion to wait 4 weeks if possible and to guide the decision to drain by imaging results (12).In the current edition Grossar et al report on the diagnosis and favorable outcome of liver abscesses in children and highlight the need to obtain invasive cultures as soon as possible (13).…”