ABSTRACT
Pyogenic liver abscess in children is uncommon in developed countries and there are few reports about the disease in developing countries including Brazil. As pyogenic liver abscesses in children are frequently diagnosed in Vitória (E. Santo State, Brazil), the records of admissions at the Children's Hospital (Hospital Infantil N. S. da Glória) were surveyed . Sixty-five cases of pyogenic liver abscess were observed over a period of three years, from May 1991 through April 1994 (mean of admissions of 2800 children/year). Fourty-seven cases occurred in boys (mean of ages 8.1 + 3.5 yr, median 8 yr) and 18 in girls (mean of ages 6.1 + 3.3 yr, median 7 yr) with a 2.7:1 male female ratio. Predisposing factors were skin infections (23 cases), bile duct ascariasis (six cases), trauma (two cases) but in 30 cases a predisposing factor was not evident. Staphylococcus aureus was the bacteria most frequently isolated (16/29 examined). Entamoeba histolytica trophozoites were never found in the exudate of abscesses and cysts were found once in fecal examination. Clinical manifestations were similar to those observed in other reports about pyogenic liver abscess in children. There was a high frequency of intestinal helminth infection (80.6 percent of 36 cases in which a fecal examination was recorded) and eosinophilia in the peripheral blood (36.2 percent of 61 cases). In addition most cases came from the urban perophery of Vitória, where intestinal parasites are frequent. These data showed that the frequency of pyogenic liver abscess in higher in Vitória (one case/138 admissions) than in developed countries (25 cases or less/100000 admissions in USA). We hypothesyse that the helminth infection (mainly with ascaris and toxocara), whose larvae migrate through the liver inducing granulomas, could enhance the localization of bacteria, increasing the risk for pyogenic liver abscess.