Navya Sree Manugu1, Narayana Lunavath2, Ramu Pedada3
BACKGROUND
Amoebic liver abscess is the commonest extra intestinal site of invasive
amoebiasis which mainly affects infants and young children. The incidence of
pyogenic liver abscess is much higher among children in developing countries
than those in developed countries. Diagnosis of liver abscess can be challenging
and is often delayed; a high index of suspicion is necessary in children with risk
factors. Children have unique set of predisposing causes for liver abscesses. The
purpose of this study was to assess the clinical, demographic, and etiological
profile of liver abscess in children between 1 month to 12 years of age.
METHODS
This is a prospective observational study conducted in the Department of
Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt.
of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi),
Delhi from July 2016 to August 2017. All children aged 1 month to 12 years
admitted with liver abscess (included consecutively) were enrolled after
considering inclusion and exclusion criteria. Written and informed consent was
taken from parents/guardians of children aged less than 7 years. Informed
assent was taken from children aged more than 7 years, along with written and
informed consent from their parents/guardians. Their clinical characteristics,
radiological features and laboratory data were analysed.
RESULTS
Most common age group suffering from liver abscess was 5 - 10 years with male
preponderance. Majority of the children belonged to lower socio-economic class
and half of them were suffering from malnutrition. Most common clinical
presentation of children suffering from liver abscess was fever with pain
abdomen and tender hepatomegaly. Majority of the children had leucocytosis,
high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Deranged liver function test with coagulopathy was noted in more than half of
the children suffering from liver abscess. Commonest bacterial pathogen was
methicillin resistant Staphylococcus aureus followed by Salmonella typhi,
Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and
Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent
causing liver abscess in children.
CONCLUSIONS
Liver abscess should be considered in children presenting with fever and
abdominal pain. Most cases involve a single lesion on right lobe of the liver.
Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the
two most common pathogens.
