A systematic review of case reports of hepatic actinomycosis

BACKGROUND AND OBJECTIVESHepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately.MATERIALS AND METHODSCase reports on HA in patients published between ۲۰۰۰ and April ۲۰۲۰ were gathered by carrying out a structured search through PubMed/Medline.RESULTS AND DISCUSSIONThrough a survey of the Medline database, ۱۳۰ studies were identified and then, ۶۴ cases with HA were included in the final analysis. Asia had the largest share of cases with ۳۷.۵% (۲۴ reports), followed by Europe and the Americas. Affected patients were predominantly males (۶۴%) and the overall mortality rate was ۱% with only one male patient in his ۵۰ s dying. Nearly all patients (۹۲%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (۸۰%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (۳۲%) and foreign bodies in the abdominopelvic region (۲۰%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (۶۶%), fever (۶۲%), weight loss (۴۸%), night sweat, malaise, and anorexia (۱۴%) over about ۳.۱ months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in ۱۸ patients (۲۸%). Histopathologic examination confirmed infection in ۶۷% of the patients and samples obtained from liver puncture biopsy (۳۲%) 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.CONCLUSIONHA 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.