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. 2021 Apr 30;16(1):192.
doi: 10.1186/s13023-021-01821-5.

A systematic review of case reports of hepatic actinomycosis

Zahra Chegini  1 , Mojtaba Didehdar  2 , Seidamir Pasha Tabaeian  3   4 , Amin Khoshbayan  1 , Aref Shariati  5
Affiliations

A systematic review of case reports of hepatic actinomycosis

Zahra Chegini et al. Orphanet J Rare Dis. .

Abstract

Background: Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately.

Methods: Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline.

Results: Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection.

Conclusion: HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.

Keywords: Actinomyces species; Actinomycosis; Diagnosis; Hepatic actinomycosis; Liver abscess.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of publication selection and their inclusion in the systematic review
Fig. 2
Fig. 2
The most common complications in patients with hepatic actinomycosis
Fig. 3
Fig. 3
Characteristic of patients with hepatic actinomycosis. RUQT Right upper quadrant tenderness, ALP alkaline phosphatase, AST aspartate transaminase, ALT alanine transaminase, CRP C-reactive protein, ESR erythrocyte sedimentation rate, CA carbohydrate antigen, AFP alpha-fetoprotein
Fig. 4
Fig. 4
Different methods that led to the diagnosis of hepatic actinomycosis. HE Histopathologic examination, PCR polymerase chain reaction
See this image and copyright information in PMC

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