Risk factors and treatment outcome in the patients of amoebic liver abscess: A prospective study from Rajasthan, India

Abstract

Background:Introduction: Amoebic liver abscess is the most common extra-intestinal manifestation of amebiasis in the tropics. Despite of improved sanitation and advancement of treatment, amebiasis is endemic throughout the tropical areas of the world. We present results of our prospective study designed to explore the risk factors and outcomes in amoebic liver abscess patients. Methods & Materials: This is an observational prospective study of 65 patients, presented in outpatient and emergency department at the hospital. All patients with amoebic liver abscess were diagnosed by ultrasonography and confirmed by serology (ELISA) were included. Clinical features and possible risk factors were documented. All patients received intravenous metronidazole as initial management for at least a week followed by oral metronidazole for 14–21 days depending on response. Catheter drainage was preferred for abscess located in left lobe or abscess volume >250 ml. Abscess volume was reassessed by ultrasonography on day 7 and 14 of admission. The effectiveness of treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement and resolution of abscess. Results: There were 65 patients with mean age of 33 ± 18 years and 57 (88%) were males. Common symptoms were abdominal pain (87%), fever (75%) and vomiting (46%). Twenty-Six (40%) patients were chronic alcoholic while 13 (20%) had coexistent diabetes. 48 patients (74%) had a single abscess and the most common site were right lobe (82%). Mean abscess volume was 226 (±20.9) ml. Twenty-two patients (34%) were managed with metronidazole alone, 23 (36%) underwent catheter drainage and 16 (25%) underwent needle aspiration. Two patients had coexistent intestinal amoebiasis. Four patients developed minimal ascites and 11(17%) had right sided reactive pleural effusion. One patient died due to coexistent urosepsis. Mean hospital stay was 20 ± 12 days, with longer hospital stay in those with catheter drainage compared to other interventions. A trend toward early abscess resolution and complete clearance was observed in catheter drainage Conclusion: Amoebic liver abscess is common among males with single right lobe abscess. Diabetes, alcoholism and poor drinking water sanitation practices are most important risk factors. Catheter drainage appeared to be better for abscess clearance and early resolution