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Pyogenic hepatic abscesses in children are often linked to sepsis or umbilical infections in infants. Older children with immune defects like chronic granulomatous disease (CGD) are also at risk, requiring prompt drainage and antibiotics.
Area of Science:
- Pediatric infectious diseases
- Hepatology
- Immunology
Background:
- Pyogenic hepatic abscess (PHA) is a rare but serious infection in children.
- Infants are particularly vulnerable due to sepsis or umbilical infections.
- Older children may present with underlying immune deficiencies, such as chronic granulomatous disease (CGD) or leukemia.
Purpose of the Study:
- To review cases of childhood pyogenic hepatic abscess.
- To identify risk factors, clinical presentations, diagnostic methods, and etiologic agents.
- To evaluate treatment outcomes and mortality rates.
Main Methods:
- Retrospective review of five cases from Milwaukee Children's Hospital.
- Meta-analysis of 61 additional cases from existing literature.
- Analysis of clinical findings, diagnostic imaging (radionuclide scan), and autopsy reports.
Main Results:
- Staphylococcus aureus was the most common pathogen.
- Fever, abdominal pain, and hepatomegaly were frequent symptoms.
- Radionuclide scans effectively diagnosed abscesses >2 cm; smaller lesions were found at autopsy.
- Mortality rates were 27% for CGD patients and 42% for non-CGD patients.
Conclusions:
- Early diagnosis and intervention are crucial for improving outcomes in pediatric pyogenic hepatic abscess.
- Open drainage combined with appropriate antibiotic therapy is the recommended treatment.
- Identifying and managing underlying host defense defects is essential for high-risk children.
Abstract:
Five cases of childhood pyogenic hepatic abscess at Milwaukee Children's Hospital and 61 cases in the literature were reviewed. Hepatic abscess occurred most often in infants who had sepsis or umbilical infection. Cases in older children were associated with underlying host defense defects, particularly chronic granulomatous disease (CGD) and leukemia. Common clinical findings were fever, abdominal pain and hepatomegaly. Radionuclide scan was useful in diagnosis of lesions larger than 2 cm. Small or microscopic lesions were diagnosed at autopsy. Staphylococcus aureus was the most common etiologic agent. Mortality in all evaluable cases was 27% in patients with CGD and 42% in those without CGD. Open drainage and appropriate antibiotic therapy is the treatment of choice and should lower the mortality of this infection.