Abstract
BackgroundWorldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers.MethodsWe performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model.ResultsWe investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5∶1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p<0.01), aged more than 41 years old (OR = 3.63, p = 0.02) and being an immigrant (OR = 11.56, p = 0.03). Percutaneous aspiration was not based on initial abscess size but was carried out significantly more often on patients who were admitted to surgical units (OR = 10, p<0.01). The median time to abscess disappearance for 24 ALA was 7.5 months.Conclusions/SignificanceIn this study on imported ALA was one of the largest worldwide in terms of the number of cases included males, older patients and foreign-born patients presented with larger abscesses, suggesting that hormonal and immunological factors may be involved in ALA physiopathology. The long lag time before developing ALA after returning to a non-endemic area must be highlighted to clinicians so that they will consider Entamoeba histolytica as a possible pathogen of liver abscesses more often.
Highlights
Amœbiasis is caused by Entamoeba histolytica (E. histolytica), a protozoan specific to humans
The results of our study reported the existence of 90 cases of imported amoebic liver abscess (ALA) in France which should raise interest among physicians as well as tourists traveling to endemic areas
Diagnosis of ALA Diagnosis of ALA relied on three criteria: travel associated exposure, presence of at least one liver abscess detected by abdominal ultrasound and/or CT scan in a symptomatic patient, and a positive serology for amœbiasis
Summary
Amœbiasis is caused by Entamoeba histolytica (E. histolytica), a protozoan specific to humans. Amœbiasis is present throughout the world, but is endemic in tropical countries where the risk of faecooral transmission is high [1]. The main clinical manifestations of amœbiasis are colitis and liver abscess (ALA) [1]. Pleuropulmonar and pericarditis forms exist but ALA is the most common extraintestinal manifestation of the disease and is one of the etiologies of febrile returning travelers. In Europe, ALA is observed in European-born travelers visiting tropical countries, and in foreign-born patients living in European countries. ALA was historically responsible for a high number of fatal cases, but since the introduction of medical treatment, the mortality rate is dropped to around 1 to 3%. Amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers
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