Clinicopathologic Characteristics and Management of Infective Liver Collections in South Africa

Background: Liver parenchyma infection by bacteria, fungi and parasitic organisms are common in HPB practices. Microbiology spectrum and management have changed over the past decade. Currently published data sparse in Africa and other LMICs Purpose: Descriptive analysis of experience with infected liver collections from 2 HPB referral centres in South Africa Method: Analysis of databases of Chris Hani-Baragwanath Academic (CHBAH) and Charlotte Maxeke Johannesburg Academic (CMJAH) hospitals and the South African National Health Laboratory Services (NHLS) records over a 5-year period. Clinicopathologic and radiology features and management were analysed. Continuous variables were as mean and ranges with categorical variables as percentages. Mann-Whitney and one way ANOVA tests for differences between groups. p values of <0.05 considered statistically significant. Results: Data of 213 patients were analyzed. Males predominated (54%) with mean age 48.8 years. HIV (24%) and diabetes (16,1%) were main comorbidities identified. 68% had pyogenic abscesses, whilst amoebic and hydatid cysts occurred in 16% and 9.2% respectively. 41% of pyogenic abscesses were cholangitic (biliary causes). 8,2% of blood cultures and 32,2 % abscess cultures were positive in the pyogenic cases. Klebsiella, E. coli and Streptococci were main isolates whilst 8% were poly microbial. Percutaneous drainage was sufficient for 68% abscesses, whilst 11% (mainly hydatid) underwent surgery. Average hospitalisation was 16 days, with a mortality rate of 3,2%. Conclusions: In this study, pyogenic abscesses, mainly of biliary etiology predominated in middle aged males. HIV co-infection was present in a quarter of patients. Non-surgical management was sufficient in majority of cases.