Pillay Krevosha, Khan Zafar Ahmed, Nweke Ekene Emmanuel, Omoshoro-Jones Jones
Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa.
Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa.
World J Hepatol. 2024 Dec 27;16(12):1417-1428. doi: 10.4254/wjh.v16.i12.1417.
Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries.
To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.
Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed.
In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group ( < 0.0002 and < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. , and were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% ( = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% ( = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%.
In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
肝脓肿是由细菌、真菌和寄生虫感染肝脏实质引起的。在过去十年中，脓肿微生物学和脓肿（感染性积液）的管理趋势发生了变化。关于撒哈拉以南非洲以及其他低收入和中等收入国家肝脓肿临床病理特征的已发表数据很少。
评估南非两家三级医院肝脓肿和肝包虫病的临床表现。
回顾并分析了从南非约翰内斯堡两家转诊医院2016年1月至2020年12月患者的电子出院小结中获取的信息。纳入所有13岁以上出现感染性肝积液（化脓性、阿米巴性）和包虫病的患者。整理并分析临床发现、实验室、微生物学、放射学结果及转归。
共纳入222例患者。男性123例（55.41%），女性99例（44.59%），中位年龄48岁。合并症包括艾滋病毒（24.23%）、高血压（20.57%）和糖尿病（16.83%）。大多数脓肿（74.77%）为化脓性，而阿米巴性和包虫性脓肿分别占16.22%和9.01%。化脓性肝脓肿（PLA）的主要病因是胆道相关疾病。与阿米巴性和包虫性脓肿组相比，化脓性脓肿组的白细胞和C反应蛋白显著更高（分别<0.0002和<0.007）。在PLA患者中，17.58%的血培养和56.60%的脓肿液培养出微生物。大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌是培养最多的微生物。16%的培养为多微生物感染。在整个研究组中，76.00%（n = 169）需要引流的患者接受了经皮肝穿刺置管引流，而8.76%（n = 19）接受了开放手术。中位住院时间为13天。死亡率为3.02%。
在本研究中，最常见的肝脓肿类型是中年男性的胆道源性PLA。微生物学与亚洲人群中描述的相似，非手术治疗（经皮引流）在大多数病例中是足够的，发病率和死亡率均可接受。
