An observational study of liver abscess in relation to its bacteriological profile (aerobic and anaerobic) and amoebic etiology

Singh Shalini; Singh Neeraj

Volume : VIII, Issue : I, January - 2019

An observational study of liver abscess in relation to its bacteriological profile (aerobic and anaerobic) and amoebic etiology

Singh Shalini, Singh Neeraj

Abstract :

Background: Liver abscesses, both amoebic and pyogenic, remain an important clinical problem in both developing and developed countries with a significant mortality rate even in the modern era. Bacterial etiology of most liver abscess cases go undetected as usually only aerobic bacteria are looked for. Detection of amoebic antigen in liver abscess pus is a recent & promising approach. Moreover, clinical presentation in both the types of liver abscesses being same, early laboratory diagnosis plays a crucial role in timely management of patients. Objectives: To assess the presence of aerobic and anaerobic bacteria and to identify amoebic etiology in liver abscess cases. Study design: Observational study. Materials and Methods: The study was conducted in the Department of Microbiology, Kempegowda Institute of Medical Sciences, Bangalore for a period of one year and six months between January 2013 to July 2014 and it comprised of Ultrasound guided aspirate of 75 liver abscess cases which were subjected to bacterial identification by direct microscopy, culture & biochemical tests. Antibiotic susceptibility test was done for aerobic organisms. For amoebic identification, wet mount was done and Enzyme–Linked Immuno Sorbent Assay (ELISA) test was performed using Techlab Entamoeba histolytica II kit for lectin antigen detection. Results: Of the 75 samples, 30 (40%) showed bacterial etiology amongst which 20 had only aerobic isolates identified as: Enterococcus spp (11), Escherichia coli (7), Klebsiella pneumoniae (4), Pseudomonas aeruginosa (3), Non–fermentative Gram–Negative Bacilli (3), Enterobacter spp (1). 7 samples had only anaerobic isolates identified as: Peptostreptococcus spp (4), Bacteroides spp (2), Fusobacterium spp (1). 3 samples had both aerobic & anaerobic isolates identified as: Bacteroides spp + Escherichia coli (2), Peptostreptococcus spp + Escherichia coli (1). Out of 75 samples analyzed for Entamoeba histolytica antigen detection test, 47 (62.6%) gave positive results including 45 (60%) suspected cases of Amoebic liver abscess and 2 (2.6%) cases showing mixed pyogenic and amoebic infection. Conclusions: Enterococcus spp and Peptostreptococcus spp are predominant aerobic & anaerobic bacteria respectively isolated in Pyogenic liver abscess. Amoebic serology performed using ELISA for antigen detection was found to be positive in significant number of cases making it a strong marker in diagnosing Amoebic liver abscess.