Microbiological flora, demography and presentation of liver abscess: A changing trend

Abstract

Objective: A prospective study in Rohilkhand region to analyse the causative organism for liver abscesses which might be helpful in planning the management of liver abscesses. Methods: Patients who were diagnosed to have liver abscess of size 5 cm or more and aspiration of pus was done either by percutaneous or by pig tail insertion were included in the study. The study includes all the patients who came in OPD or admitted in the hospital. The study was conducted for a period of one year. Results: The prevalence of liver abscess shows male predominance. Age dependency with significantly higher prevalence in the age group of 35 to 55 years. Right upper quadrant pain, fever and anorexia was seen in 64 (91%), 55 (78 %) and 50 (71 %) cases respectively. Patients with amoebic liver abscesses were more associated with diarrhea and cough while fever, pain in right upper abdomen and nausea or vomiting was more associated with pyogenic liver abscesses. The most common organism cultured was Klebsiella pneumoniae (23.3%) followed by Escherichia coli (13.3%)..The detection of E. histolytica in aspirated pus was 70 % while only 10 % in stool samples. Conclusion: Pyogenic liver abscess can be monomicrobial or polymicrobial and may be associated with amoebic liver abscess. Abscesses, which were previously thought to be “sterile” or cryptogenic, may in fact be caused by anaerobic organisms that were not previously identified secondary to inadequate technique. Compared to pyogenic liver abscesses, patients with amoebic abscesses are often younger, more acutely ill and are usually from high prevalence areas. The sensitivity of PCR was higher as compared with microscopy in this study in detecting E. Histolytica.