Abstract

Background Extraintestinal amoebiasis is an uncommon complication of Entamoeba histolytica infection, occurring in about 5-10% of patient. Prompt diagnosis and management is essential to prevent complications. However, diagnosis and management in resource-limited settings is very challenging owing to limited diagnostic tools and nonspecific clinical symptoms. Therefore, our case report underscores the role of incisive clinical evaluation, basic investigation, and nonsurgical management of giant amoebic abscess in resource-limited settings. Case Presentation. A 13-year-old female Cameroonian presented with subacute onset of upper abdominal pain, high fever, and chest pain for one week. Before presentation, she had been on treatment at a local traditional practitioner during which her symptoms worsen. After clinical evaluation and basic investigation, she was diagnosed with a giant amoebic liver abscess. She was resuscitated and placed on nonsurgical management. Follow-up after 1 month was significant for complete recovery. Conclusion Amoebic liver abscess is a rare complication of Entamoeba histolytica infection with devastating complications. The diagnosis of this disease requires high index of suspicion in resource-limited settings. Good clinical evaluation and timely nonsurgical therapy can provide recovery to some patients.

Highlights

  • Extraintestinal amoebiasis is an uncommon complication of Entamoeba histolytica infection, occurring in about 5-10% of patient

  • Our case report elaborates the importance of good clinical skills and nonsurgical management of giant amoebic liver abscess in rural communities with unsophisticated health care delivery facilities

  • The analyses revealed a hemoglobin of 8 g/dl, WBC 25,000 cells/μl, human immunodeficiency virus (HIV) test: negative, and malaria RDT test: negative

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Summary

Background

Infection is acquired via ingestion of mature quadrinucleated cyst in contaminated food or water. These matured cysts are capable of living in the external environment for up to 10 days and are resistant to gastric acid and unfavorable environmental conditions because of their thick walls. The pathogenesis of amoebiasis is mediated by binding of the trophozoites to the specific receptors expressed in the large intestinal epithelium. These metacyclic trophozoites express Gal/GalNAc lectin which binds to galactose and N-acetyl-D-galactosamine residues found on O-linked sugar side chains of mucins [6, 7]. The trophozoites can break through the intestinal wall into the peritoneum and portal circulation, where they migrate to the liver, lung, and other extraintestinal sites causing severe disease [1]

Clinical Presentation
Case Report
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