Clinical Manifestations and Etiology of Liver Abscess in Children in Tertiary Care Hospital

Abstract

Background: The liver is a major metabolic organ with a dual blood supply, hence vulnerable to infection. The liver abscess (LA) is a space-occupying lesion in the liver parenchyma filled with pus caused by bacteria, parasites, or fungus. Objective: To determine the clinical manifestations and etiology of liver abscess among children presenting at a tertiary care hospital. Methodology: This descriptive cross-sectional study was conducted at the medical department of the National Institute of Child Health, Karachi, Pakistan from July 2022 to December 2022. A total of 147 children of either gender aged below 12 years with liver abscesses were analyzed. At the time of enrollment, demographic features, clinical features, characteristics, and etiological agents of LA. The cause of the liver abscess was confirmed by pus culture, blood culture, and indirect haemagglutination assay (IHA). Aspiration was performed among cases who had LA>5cm and liquefication of abscess. Results: Of a total of 147 children with LA, 96 (65.3%) were boys. The mean age was 7.08±2.61 years. Socioeconomic status of 112 (76.2%) children was poor. In terms of frequency of presenting features/complaints, pyrexia (100%) and abdominal pain (98.6%) were the most commonly found whereas hepatomegaly (98%) and right hypochondrium tenderness (97.3%) were the commonest signs. The right hepatic lobe was involved in 120 (81.6%) LA cases and the majority of LA were solitary (93.2%). The size of the liver in 57 (38.8%) LA cases was between 3-6 cm while 93 (63.3%) cases were aspirated. The etiological diagnosis revealed that bacterial involvement was found in 36 (24.5%) LA cases while amoebic presence was noted in 75 (51.0%) cases. No cases of fungal involvement were found. Conclusion: A predominance of male gender and low socioeconomic status was found among children with LA presenting at a tertiary care hospital in Karachi, Pakistan. The most frequent presenting complaints were pyrexia and abdominal pain. Amoebic presence was the most common etiologic agent behind LA.