Pediatric hepatic abscess: A ten-year review of the features and outcome at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.</p><p style="text-align: justify;"><strong>Method.</strong> We conducted a review of medical records of admitted patients aged ?18 years diagnosed with hepatic abscess in a tertiary referral center from 2007-2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.</p><p style="text-align: justify;"><strong>Result.</strong> We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.</p>

Liver Abscess Harbors Melioidosis: A case report on this rare finding in a potentially endemic community

Introduction@#Melioidosis among Filipinos may be underreported. The causative agent, Burkholderia pseudomallei, thrives in soil and water in tropical regions. Because our country thrives on agriculture as a source of livelihood, occupational exposure through farming needs to be recognized. @*Case Presentation@#We report a case of a 40-year-old male complaining of intermittent fever, progressive weight loss and jaundice for three weeks prompting consult. Whole abdominal ultrasound showed presence of a hepatic mass. Further evaluation using CT scan of the whole abdomen with contrast revealed multiple cystic hepatic nodules with wall/septal enhancement. He was admitted and was initially managed as sepsis secondary to a complicated intra-abdominal infection (liver abscess, pyogenic or amebic). Ciprofloxacin and metronidazole were started. Aspiration of the hepatic abscess showed many pus cells. Culture of the aspirate grew Burkholderia pseudomallei, sensitive to ceftazidime. Antibiotics were shifted accordingly. Defervescence ensued. Patient was discharged improved after two weeks of ceftazidime wo grams every eight hours given intravenously followed by a three-month oral course of cotrimoxazole 160mg/800mg tablet, two tablets every 12 hours and doxycycline 150mg capsule every 12 hours. On follow-up after three months, he had no recurrence of symptoms and was able to resume his usual work.@*Discussion@#Melioidosis is a disease of humans and animals that is geographically restricted to tropical countries since the organism thrives in soil and water. Symptom onset may be delayed due to the ability of the organism to produce latent infection. Isolation of B. pseudomallei from clinical specimens sent for culture and sensitivity testing is the diagnostic gold standard.@*Conclusion@#Melioidosis may present as an intraabdominal infection. A high clinical index of suspicion among those with occupational exposure to contaminated soil and water is important to promptly recognize and treat this infection.

Algoritmos útiles para el diagnóstico histopatológico de la enfermedad hepática con base en los patrones de daño hepático / Useful Algorithms for Histopathological Diagnosis of Liver Disease Based on Patterns of Liver Damage

En los anteriores artículos, se revisaron las patologías hepáticas más frecuentes desde el punto de vista morfológico y la importancia de una adecuada correlación, para lograr un mejor entendimiento entre clínicos y patólogos. El ejercicio que se hará a continuación, se basa en establecer una aproximación al diagnóstico histopatológico de algunas de las patologías hepáticas a las que se les realiza biopsias con mayor frecuencia, teniendo en cuenta algoritmos basados en patrones de daño hepático

Previous articles have reviewed the most frequent liver pathologies from the morphological point of view and looked at the importance of adequate correlation for obtaining better understanding between clinicians and pathologists. The next exercise is directed toward histopathological diagnosis of some of the liver diseases for which biopsies are performed most frequently. It takes into account algorithms based on patterns of liver damage

Pseudotumor inflamatorio por Fasciola hepática: a propósito de un caso / Inflammatory pseudotumor by Fasciola hepática: a case report

Introduction: Fasciola hepatica is a parasite of the class Trematoda. It commonly has been found in developing countries. When it infects humans is characterized by a triad of fever, pain in right upper quadrant and peripheral eosinophilia. We present a 67-year-old female from a rural town of the north of Lima, Peru, it was found abdominal pain, eosinophilia and focal hepatic lesions. For this reason, a hepatic mass was the initial suspicion. The hepatic biopsy was performed and one of the findings was eosinophilia. Fasciola hepatica infection should be considered as part of differential diagnosis in hepatic tumors with eosinophilia when the origin of the patient is from endemic areas of F. hepatica.

Fasciola hepática es un parásito de la clase Trematoda común en países en desarrollo. La infección en el ser humano se caracteriza por la triada de fiebre, dolor abdominal en el cuadrante superior derecho y eosinofilia. Se presenta el caso de una mujer de 67 años procedente de una zona rural al norte de Lima, con historia de dolor abdominal de seis meses de evolución, con una imagen hipodensa hepática en el TAC abdominal y eosinofilia. La biopsia hepática mostró un infiltrado inflamatorio con eosinofilia. En el diagnóstico diferencial en pacientes con un tumor hepático y eosinofilia, se deben incluir infecciones parasitarias como F. hepatica; sobre todo en pacientes que proceden de áreas endémicas.