Bacterial versus parasitic liver abscesses in children: a retrospective cohort study of clinical and laboratory differences

This study aimed to describe the clinical and laboratory differences between bacterial and parasitic liver abscesses in pediatric patients. We retrospectively reviewed all pediatric cases of liver abscess diagnosed and treated at the National Children’s Hospital (NCH), Hanoi, between January 2018 and July 2024. Clinical characteristics, laboratory parameters, and imaging findings were compared between bacterial and parasitic etiologies. This retrospective study included 80 children aged 1 month to 15 years diagnosed with liver abscess between 2018 and 2024. Overall, 85% of the patients resided in rural or mountainous areas, 60% were male, and nearly all (95%) were older than 6 months. Bacterial abscesses were significantly associated with high-grade fever (90.3% vs. 36.7%; p < 0.005), hepatomegaly (87.1% vs. 63.3%; p < 0.05), and splenomegaly (22.6% vs. 4.1%; p < 0.05). Patients with bacterial abscesses presented increased neutrophil percentages (61.5%), whereas those with parasitic abscesses presented a markedly increased incidence of eosinophilia > 10% (81.6% vs. 9.7%). Elevated CRP levels (> 100 mg/L) were more common in bacterial cases than in parasitic cases (54.8% vs. 24.5%). On imaging, solitary lesions were more common in bacterial abscesses (58.1%), whereas multiple cavities predominated in parasitic infections (73.5%). Liver abscesses affected children most significantly in the over 6-month old and were more common in males, particularly those from rural or mountainous areas. Nonspecific presentations hinder early diagnosis; however, clinical features including high fever and hepatosplenomegaly, CRP levels, eosinophil counts, and characteristic imaging findings may assist in distinguishing bacterial from parasitic etiologies and support earlier targeted management.