Liver abscess: diagnostic and management issues found in the low resource setting

Abstract Introduction Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. Sources of data We searched PubMed for relevant reviews by typing the following keywords: ‘amoebic liver abscess’ and ‘pyogenic liver abscess’. Areas of agreement Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. Areas of controversy In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. Growing points As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. Areas timely for developing research The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.

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Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

BMJ Global Health ◽

10.1136/bmjgh-2021-005190 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005190

Author(s):

Chanel van Zyl ◽

Marelise Badenhorst ◽

Susan Hanekom ◽

Martin Heine

Keyword(s):

Content Analysis ◽

Scoping Review ◽

Qualitative Content Analysis ◽

Middle Income ◽

Low Resource Settings ◽

Low Resource ◽

Middle Income Countries ◽

Resource Setting ◽

Low Resource Setting ◽

Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

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Clinicopathological study on presentation, diagnosis and management of liver abscess in Bhopal region

International Surgery Journal ◽

10.18203/2349-2902.isj20173391 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2572

Author(s):

Anshul Siroliya ◽

Mahendra Damor ◽

M. C. Songra

Keyword(s):

Observational Study ◽

Liver Abscess ◽

Prospective Observational Study ◽

Pyogenic Liver Abscess ◽

Amoebic Liver Abscess ◽

Age Group ◽

Catheter Drainage ◽

Liver Abscesses ◽

Male Preponderance ◽

Amoebic Abscess

Background: This prospective observational study is carried out to study cases of liver abscess and to determine demographic profile, spectrum of clinical presentations, aetiology, laboratory investigations. The objective of the study was to evaluate efficacy of Ultrasonographic (radiological) studies in determining the aetiology and in differentiating from other liver pathologies which may change the treatment outcome, bacteriological and serological characteristics, to study the influence of alcohol, diabetics and immunocompromised diseases (esp. HIV) leading to increased incidence of liver abscess and to evaluate efficacy, recurrence rate, complications, morbidity and mortality, duration of hospital stay associated with different management Strategies.Methods: This prospective observational study was carried out in Department of Surgery, Gandhi Medical College Bhopal and Associated Hamidia Hospital, Bhopal between July 2015 to October 2016.Results: Amoebic abscess (74%) is more common than pyogenic abscess (26%). Amoebic abscess is common in the age group of 31-50 years (73%), pyogenic in the age group of 51-70 years (73.1%). Male preponderance is found in case of amoebic liver abscess (90.5%). Right lobe involvement in common. Right upper quadrant pain, tenderness and fever are the most common clinical features. Alcoholism is most common risk factor (71.6%) and diabetes mellitus has strong association with pyogenic liver abscess (15.4%). E coli (19.2%) and klebsiella (11.5%) are the most common organisms cultured. Medical therapy is more useful in case of amoebic liver abscess (58.1%) while catheter drainage is more useful in case of pyogenic liver abscess (61.5%). Pleuropulmonary complications are much more common and complications rate is more common among pyogenic group.Conclusions: In our study, alcohol was found to be the most common predisposing factor for liver abscesses (68%), this underpin the finding of other studies. Amoebic liver abscess is a medically treated common infection prevailing in unhygienic condition, affecting people mostly between 30-40 years of age whereas pyogenic liver abscess patient commonly falls between 50-70 years age group. Both liver abscesses show a male preponderance. The present study also corroborates the catheter drainage procedure as a superior modality in treating pyogenic liver abscess.

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Secondary pleuropulmonary amoebiasis due to liver abscess rupture: A complication case report in low resource setting

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106231 ◽

2021 ◽

pp. 106231

Author(s):

Putri Mega Juwita ◽

Resti Yudhawati

Keyword(s):

Case Report ◽

Liver Abscess ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Tropical Medicine for Anaesthetists

Global Anaesthesia ◽

10.1093/med/9780198809821.003.0013 ◽

2020 ◽

pp. 297-318

Author(s):

Victoria Howell

Keyword(s):

Clinical Features ◽

Tropical Medicine ◽

Tropical Diseases ◽

Middle Income ◽

Low Resource ◽

Middle Income Countries ◽

High Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Significant Burden

Many tropical diseases will be unfamiliar to anaesthetists from high-resource settings but are common in low- and middle-income countries. They lead to a significant burden of morbidity and mortality, and some knowledge of the commonly presenting ones and how they might impact on conduct of anaesthesia is essential to anaesthetists practising in these settings. The chapter covers the essentials of several tropical diseases including malaria, tuberculosis, cholera, and typhoid. The chapter outlines for each disease the aetiology, pathophysiology, clinical features, diagnosis, management, and anaesthetic implications. Diseases that are also found in high-resource settings, such as diarrhoea and HIV, are also covered on the basis that they are much more likely to be encountered in a low-resource setting.

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Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study

Cardiology in the Young ◽

10.1017/s104795111900252x ◽

2019 ◽

Vol 29 (12) ◽

pp. 1481-1488 ◽

Cited By ~ 1

Author(s):

Aparna Vijayaraghavan ◽

Abish Sudhakar ◽

Karimassery Ramiayar Sundaram ◽

Raman Krishna Kumar ◽

Balu Vaidyanathan

Keyword(s):

Prenatal Diagnosis ◽

Risk Index ◽

Clinical Status ◽

Term Infants ◽

Middle Income ◽

Low Resource ◽

Intention To Treat ◽

Resource Setting ◽

Low Middle Income Countries ◽

The Impact

AbstractBackground:Prenatal diagnosis and planned peri-partum care is an unexplored concept for care of neonates with critical CHDs in low-middle-income countries.Objective:To report the impact of prenatal diagnosis on pre-operative status in neonates with critical CHD.Methods:Prospective observational study (January 2017–June 2018) in tertiary paediatric cardiac facility in Kerala, India. Neonates (<28 days) with critical CHDs needing cardiac interventions were included. Pre-term infants (<35 weeks) and those without intention to treat were excluded. Patients were grouped into those with prenatal diagnosis and diagnosis after birth. Main outcome measure was pre-operative clinical status.Results:Total 119 neonates included; 39 (32.8%) had prenatal diagnosis. Eighty infants (67%) underwent surgery while 32 (27%) needed catheter-based interventions. Pre-operative status was significantly better in prenatal group; California modification of transport risk index of physiological stability (Ca-TRIPS) score: median 6 (0–42) versus 8 (0–64); p < 0.001; pre-operative assessment of cardiac and haemodynamic status (PRACHS) score: median 1 (0–4) versus 3 (0–10), p < 0.001. Age at cardiac procedure was earlier in prenatal group (median 5 (1–26) versus 7 (1–43) days; p = 0.02). Mortality occurred in 12 patients (10%), with 3 post-operative deaths (2.5%). Pre-operative mortality was higher in postnatal group (10% versus 2.6%; p = 0.2) of which seven (6%) died due to suboptimal pre-operative status precluding surgery.Conclusion:Prenatal diagnosis and planned peri-partum care had a significant impact on the pre-operative status in neonates with critical CHD in a low-resource setting.

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Liver abscess: demographic, clinical, biochemical, imaging and microbial spectrum

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195526 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4607

Author(s):

Abdul Rabb Bhutto ◽

Amanullah Abbasi ◽

Shumaila Rafi ◽

Ali Hassan Abro

Keyword(s):

Clinical Features ◽

Liver Abscess ◽

Immunosuppressive Treatment ◽

Pyogenic Liver Abscess ◽

Amoebic Liver Abscess ◽

Common Symptom ◽

College Hospital ◽

Cross Sectional ◽

Aggressive Approach ◽

Liver Abscesses

Background: Liver abscesses are localized suppurative destruction of liver tissue due to infections of either bacterial (Pyogenic) or protozoa (Amoebic). Historically; pyogenic liver abscess has been described since the time of hippocrates (400 BC). Despite the more aggressive approach to treatment, the mortality rate remained at 60-80%.Methods: This Cross-sectional analytical study carried out at Department of Medicine, Al-Tibri Medical College Hospital, Karachi, from June 2017 to December 2018. All participants of either gender with diagnosis of liver abscess were included in this prospective study. Patients with co morbidities like malignancy, autoimmune disease or on immunosuppressive treatment for any reason were excluded from the study. Following confirmation of the diagnosis; different characteristics of either type of liver abscess like demographic, clinical features, biochemical and imaging findings were evaluated.Results: Data of 73 subjects, 65(89.0%) males and 08(11.0%) females were analyzed with mean age was 45.42±14.518 years. Fifty-four (73.97%) patients had pyogenic liver abscess while amoebic liver abscess was found in 19(26.03%) subjects. Clinically, the most common symptom was abdominal pain, found in 66(90.4%) subjects, followed by fever in 61(83.6%), hepatomegaly in 47(64.4%), jaundice in 18(24.7%) and vomiting in 10(13.7%) cases. Demographics and clinical features are shown in (Table 1).Conclusions: Local trends have been changing and majority of liver abscess were of pyogenic liver abscesses. Clinically, clear differentiation between two types of abscesses is not possible always but few manifestations like typical symptoms, raised alkaline phosphatase and leucocytosis may be helpful.

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Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽

10.2337/db18-93-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 93-LB

Author(s):

EDDY JEAN BAPTISTE ◽

PHILIPPE LARCO ◽

MARIE-NANCY CHARLES LARCO ◽

JULIA E. VON OETTINGEN ◽

EDDLYS DUBOIS ◽

...

Keyword(s):

Dose Adjustment ◽

Insulin Dose ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Quality indicators and post operative outcome of ERCP performed in a low resource setting ; can quality indicators from developed settings be applied?

10.26226/morressier.59a6b34bd462b80290b557f5 ◽

2017 ◽

Author(s):

Supun Kulatunge

Keyword(s):

Quality Indicators ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Operative Outcome

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Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

BMJ Case Reports ◽

10.1136/bcr-2020-239250 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239250

Author(s):

Vijay Anand Ismavel ◽

Moloti Kichu ◽

David Paul Hechhula ◽

Rebecca Yanadi

Keyword(s):

Plastic Material ◽

Successful Outcome ◽

Paraduodenal Hernia ◽

Transparent Plastic ◽

Low Resource ◽

Entire Small Bowel ◽

Resource Setting ◽

Low Resource Setting ◽

Right Paraduodenal Hernia ◽

Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

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