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The role of microbes and parasites in recurrent pyogenic cholangitis

Zuber Ansari1, Sukanta Ray2, Somak Das2

  • 1Division of Surgical Gastroenterology, Department of General Surgery, FH Medical College and Hospital, Agra, India.

Turkish Journal of Surgery
|December 4, 2024
PubMed
Abstract

Insights

Hepatobiliary ascariasis was found in 14.8% of recurrent pyogenic cholangitis (RPC) patients in India, suggesting a potential link. Recurrent pyogenic cholangitis cases were also associated with multi-drug-resistant bacteria, indicating carbapenems as a possible treatment.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Microbiology

Background:

  • Recurrent pyogenic cholangitis (RPC) is prevalent in Eastern India, with its exact cause debated.
  • Hepatobiliary Ascaris infestation is a suspected factor in RPC pathogenesis in Eastern Asia, but Indian data is limited.
  • RPC is frequently linked to multi-drug-resistant (MDR) bacteria, contributing significantly to patient morbidity and mortality.

Purpose of the Study:

  • To investigate the potential role of hepatobiliary ascariasis in the development of RPC.
  • To characterize the microbial profile of RPC patients.
  • To evaluate the implications of microbial findings for managing RPC.

Main Methods:

  • A comparative study of consecutive patients with biliary stones undergoing surgery from March 2020 to December 2021 in Eastern India.
  • Patients were categorized into RPC and non-RPC groups.
  • Bile and biliary stone samples were analyzed for bacterial culture, microscopy, and histopathology to detect ascariasis and identify microbial pathogens.

Main Results:

  • Hepatobiliary ascariasis was identified in 14.8% of RPC patients (8 out of 54), with no cases found in the non-RPC group.
  • Klebsiella was the predominant bacterial pathogen isolated from bile.
  • A high incidence of MDR pathogens (79%) was observed in RPC patients, with carbapenem antibiotics showing the highest sensitivity (66.6%).

Conclusions:

  • The study indicates a higher prevalence of hepatobiliary ascariasis in RPC patients, although a definitive etiological link requires further investigation.
  • RPC is strongly associated with a high prevalence of MDR bacteria.
  • Carbapenems may be considered a suitable empirical antibiotic choice for managing RPC.
Keywords:
Ascariasischolangitismultidrug resistance

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