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Amebic liver abscess in children
Insights
Amebic liver abscesses in children often present with fever, GI symptoms, and respiratory issues. Early diagnosis and treatment with agents like metronidazole are crucial for survival, as nearly half of the patients in this study died.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Medical Imaging
Background:
- Amebic liver abscess (ALA) is a significant cause of morbidity and mortality in children, particularly in endemic areas.
- Understanding the distinct clinical and diagnostic features of pediatric ALA is essential for timely intervention.
Observation:
- The majority of pediatric ALA cases (91%) occurred in children under 3 years old, with a predilection for the right hepatic lobe (77%).
- Common presentations included fever, gastrointestinal distress, and respiratory symptoms (cough, difficulty breathing).
- Physical examination frequently revealed hepatomegaly (81%), sometimes with a palpable mass.
Findings:
- Hematologic abnormalities such as anemia and neutrophilia were prevalent.
- Imaging studies, including intravenous pyelograms, liver-spleen scans, and abdominal ultrasounds, were critical for diagnosis, revealing kidney displacement and filling defects.
- While drainage procedures were common (9% open, 77% closed), mortality remained high at 46%.
Implications:
- Prompt recognition of clinical and laboratory signs of ALA in children can improve diagnostic speed.
- Effective treatment regimens involving metronidazole or other antiamebic drugs are vital for improving outcomes.
- Further research into risk factors and preventative strategies for pediatric ALA is warranted.
Abstract:
Five children with amebic liver abscesses are presented, and the distinctive clinical and laboratory features for these and 119 other children are described. The majority (91%) were less than 3 years old, and 77% had an isolated abscess in the right hepatic lobe. Each child presented with a history of fever and gastrointestinal symptoms, and two-thirds presented with cough or difficulty breathing. Most (81%) patients had hepatomegaly on physical examination and some had a well-defined mass. Hematologic abnormalities including anemia, neutrophilia and an increased ratio (greater than 0.15) of immature neutrophils to total neutrophils were commonly observed at the time of admission. Of interest, intravenous pyelograms revealed deviation of the right kidney due to hepatomegaly in each of three children studied. All patients evaluated had one or more filling defects demonstrated by liver-spleen scan or abdominal ultrasound. Most patients underwent either an open (9%) or closed (77%) drainage procedure. Fifty-six children (46%) died, in some cases before specific therapy was instituted. Of those who recovered all received therapy with metronidazole or a combination of chloroquine with emetine or dehydroemetine.