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A systematic review of case reports of hepatic actinomycosis
Zahra Chegini1, Mojtaba Didehdar2, Seidamir Pasha Tabaeian3,4
1Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
Hepatic actinomycosis (HA) is a liver infection often diagnosed late. Early, accurate diagnosis of HA can prevent extensive surgery and improve patient outcomes.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Hepatic actinomycosis (HA) is a rare infection that can lead to significant patient morbidity if not diagnosed and treated promptly.
- Timely and appropriate diagnosis is crucial for effective management and prevention of complications.
Purpose of the Study:
- To analyze case reports of hepatic actinomycosis published between 2000 and April 2020.
- To understand the demographics, clinical presentation, complications, diagnosis, and treatment of HA.
Main Methods:
- A structured literature search was conducted using PubMed/Medline.
- 64 confirmed cases of HA from 130 identified studies were included in the analysis.
Main Results:
- The majority of HA cases occurred in Asia, predominantly in immunocompetent males.
- Common complications included a history of abdominal surgery and foreign bodies.
- Actinomyces israelii was the most frequent pathogen; abdominal pain and fever were key symptoms. Histopathology and liver biopsy were common diagnostic tools.
Conclusions:
- Hepatic actinomycosis should be considered in patients presenting with subacute or chronic liver inflammation.
- Accurate and timely diagnosis can avert the need for extensive surgical interventions.
Background:
Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately.
Methods:
Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline.
Results:
Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection.
Conclusion:
HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.
