{"title":"北印度三级医院住院儿童肝脓肿的临床、人口统计学和病因学分析","authors":"Navya Sree Manugu, Narayana Lunavath, Ramu Pedada","doi":"10.18410/jebmh/2021/629","DOIUrl":null,"url":null,"abstract":"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. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"46 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical, Demographic, and Aetiological Profile of Liver Abscess in Children Admitted at a Tertiary Care Hospital - North India\",\"authors\":\"Navya Sree Manugu, Narayana Lunavath, Ramu Pedada\",\"doi\":\"10.18410/jebmh/2021/629\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"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. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children\",\"PeriodicalId\":15779,\"journal\":{\"name\":\"Journal of Evidence Based Medicine and Healthcare\",\"volume\":\"46 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-10-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Evidence Based Medicine and Healthcare\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.18410/jebmh/2021/629\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Evidence Based Medicine and Healthcare","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.18410/jebmh/2021/629","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
阿米巴肝脓肿是侵袭性阿米巴病最常见的肠外部位,主要影响婴幼儿。发展中国家儿童化脓性肝脓肿的发病率远高于发达国家儿童。肝脓肿的诊断可能是具有挑战性的,往往延迟;对于有危险因素的儿童,高度的怀疑指数是必要的。儿童的肝脓肿有独特的易感原因。本研究的目的是评估1个月至12岁儿童肝脓肿的临床、人口统计学和病因学特征。方法:本研究是一项前瞻性观察性研究,于2016年7月至2017年8月在德里Chacha Nehru Bal Chikistalaya儿科(德里NCT(国家首都地区)政府下属的自治研究所,附属于德里大学)进行。在考虑纳入和排除标准后,纳入所有1个月至12岁的肝脓肿患儿(连续纳入)。从7岁以下儿童的父母/监护人处取得书面和知情同意。知情同意书取自7岁以上儿童,并附有其父母/监护人的书面知情同意书。分析其临床特点、放射学特征及实验室资料。结果肝脓肿发病年龄以5 ~ 10岁年龄组居多,男性居多。大多数儿童属于较低的社会经济阶层,其中一半患有营养不良。儿童肝脓肿最常见的临床表现是发热、腹痛和肝肿大。多数患儿有白细胞增多、c反应蛋白(CRP)和红细胞沉降率(ESR)升高。肝脓肿患儿半数以上肝功能失常伴凝血功能障碍。最常见的病原菌为耐甲氧西林金黄色葡萄球菌,其次为伤寒沙门氏菌、嗜麦芽窄养单胞菌、凝固酶阴性金黄色葡萄球菌和人型葡萄球菌。溶组织内阿米巴是引起儿童肝脓肿的常见寄生虫。结论:以发热和腹痛为表现的儿童应考虑肝脓肿。大多数病例只在肝右叶有一个病灶。耐甲氧西林金黄色葡萄球菌和伤寒沙门氏菌是两种最常见的病原体。关键词:小儿肝脓肿,阿米巴性肝脓肿,化脓性肝脓肿,儿童
Clinical, Demographic, and Aetiological Profile of Liver Abscess in Children Admitted at a Tertiary Care Hospital - North India
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. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children