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Amoebic liver abscess

  • Due to infection with the protozoan parasite Entamoeba histolytica
  • Found in the stool of carriers in the cystic or trophozoite form
  • Transmitted by the faecal-oral route
  • The liver is the commonest extraintestinal site of infection
  • 10% of affected patients develop liver abscesses
  • Liver abscesses can be solitary or multiple
  • 80% of abscess develop in right lobe of the liver
  • Can present several years after intestinal infection

Clinical features

  • Presents with malaise pyrexia and weight loss
  • Right hypochondrial pain is often mild
  • Less than 20% of patients present with diarrhoea
  • Jaundice is uncommon
  • Complications can arise as a result of abscess rupture or extension of infection
  • Complications occur in 5% patients and include:
    • Amoebic empyema
    • Hepato-bronchial fistula
    • Lung abscess
    • Pericarditis
    • Peritonitis

Investigations

  • Serology shows raised WCC and ESR
  • Latex agglutination assay positive in more than 90%
  • Sigmoidoscopy, stool microscopy and rectal biopsy may identify the organism
  • Chest x-ray may show a raised right hemidiaphragm, atelectasis or abscess
  • The abscess can often be identified on ultrasound
  • Aspiration produces a typical 'anchovy sauce' appearing pus
  • Pus is odourless and sterile on routine culture

Management

  • Metronidazole is the antibiotic of choice
  • If ineffective chloroquine and dihydrometine may be considered
  • Ultrasound guided aspiration may be useful
  • Surgery is only rarely required
  • Prognosis in uncomplicated cases is good (<1%)
  • If pulmonary complications occur mortality cab as high as 20%

Bibliography

Greenstein A J, Barth J, Dicker A et al.  Amebic liver abscess: a study of 11 cases compared with a series of 38 patients with pyogenic liver abscess. Am J Gastroenterol 1985; 80: 472-475.

 

 
 

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