DOI: 10.1097/ms9.0000000000005352 ISSN: 2049-0801

Epidemiology, pathology, diagnosis, and management of amoebic liver abscesses in Sub-Saharan Africa: a retrospective cross-sectional study

Jacques Noel Tendeng, Guillaume Tcheutchoua Soh, Ousmane Thiam, Diago Anta Dia, Ablaye Ndiaye, Latyr Diagne, Armel Franck Tene Nde, Mohamed Lamine Diao, Philippe Manyacka Ma Nyemb, Ibrahima Konate
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Background:

Amoebic liver abscesses are more common in lower-income countries. Diagnosis and treatment remain challenging in Sub-Saharan Africa. This study aimed to describe the epidemiology, pathology, diagnosis, and treatment of amoebic liver abscesses at our center.

Methods:

This retrospective cross-sectional study was conducted over 7 years (January 2016–December 2022) in the general surgery department of a tertiary referral center in our region. The study included all patients admitted to our department with amoebic liver abscesses. The primary outcomes were demographics, as well as the clinical, biological, and morphological presentation of the disease, along with the interventions and outcomes of the patients.

Results:

We identified 102 patients with amoebic liver abscesses, representing 67.7% of all liver abscesses admitted. The mean age was 30.49 ± 15.05 years (3–60 years). A total of 80.4% were men, with a sex ratio of 4.1. The main risk factors were alcohol consumption (15.7%), diabetes (7.8%), and previous dysentery (82.4%). The mean symptom duration was 19.8 days (1–34). The classic symptomatic triad (hepatomegaly, pain, and fever) was present in 78.4% of the patients. Imaging investigations were performed using ultrasound in 82.4% and computer tomography in 44.1% of patients. The mean size of the abscesses was 9 ± 3.1 cm (4.3–17). The abscess was single in 92.2% of cases and ruptured in 16.7% of patients. Antibiotherapy was combined with continuous percutaneous drainage in 25.5% ( n = 26) and surgical drainage in 12.7% ( n = 13) of the patients. Abscesses that ruptured in the abdominal cavity were treated by laparotomy, and those that ruptured in the thorax were treated by thoracic drainage. The mean length of hospital stay was 10.98 ± 4.5 days, and the mean duration of drainage was 6.9 ± 1.9 days. The mortality rate was 1% ( n = 1). Factors associated with rupture were hypoalbuminemia, presence of hepatomegaly, subcapsular location, multiple abscesses, and children.

Conclusions:

Amoebic liver abscess is a common condition in our area. We lack rapid and accessible diagnostic facilities to adapt antibiotics specifically to amoebae. Therefore, the scientific community must take swift action to establish diagnostic methods or predictive scores for the etiology of liver abscesses caused by amoebae.

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