Amoebic Liver Abscess Research Articles

Amebiasis as the Cause of Pediatric Fever of Unknown Origin

Amebiasis is a parasitic infection caused by the protozoa Entamoeba histolytica. It is capable of causing a spectrum of illnesses from asymptomatic infection, to dysentery and invasive extra-intestinal conditions, the most common of which is liver abscess. Here is presented the case of a 14-month old boy presented with Fever of Unknown Origin, which after work-up was diagnosed as amebic liver abscess. Although amebiasis is more prevalent in developing countries the increasing phenomena of migration and tourism has transformed it into a global health issue. It is recommended to maintain a high index of suspicion while valuating a child with Fever of Unknown Origin.

CLINICAL, BIOCHEMICAL, AND IMAGE CHARACTERISTICS IN PATIENTS WITH A DIAGNOSIS OF AMEBIC AND BACTERIAL LIVER ABSCESS.

A hepatic abscess (HA) accumulates purulent material in the liver parenchyma and can be of bacterial, parasitic, fungal, or mixed origin. The incidence ranges from 2.3 to 22 per 100,000 people. In Mexico, the annual incidence of amoebic liver abscess is 6.7 per 100,000 population. To determine the clinical, biochemical, and imaging characteristics in patients diagnosed with amoebic and bacterial liver abscess. Research design: Descriptive, cross-sectional/prevalence. We analyzed medical records of patients admitted during 2019 with a diagnosis of liver abscess and who had an amoeba PCR test. The qualitative variables were expressed in frequencies and percentages; the numerical variables were mean and standard deviation. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of a total of 32 patients admitted with a liver abscess in Gastroenterology during 2019, 20 patients treated with drainage and PCR test for amoeba of the abscess fluid were included. Of these, 85%(17) were men with a mean age of 45.35±10.93 years, and 55%(11) were of bacterial etiology. Regarding the characteristics due to their etiology (amoebic vs. bacterial): 30%(6) were presented in segments VII and VIII; [33.3%(2/6) amoebic vs. 66.7%(4/6) bacterial]. According to the number, they were multiple; 28.6%(2/7) amoebic vs 71.4%(5/7) bacterial, unique; 53.8%(7/13) amoebic vs 46.2%(6/13) bacterial, without significant difference (p = 0.37). 60%(12) presented with pleural effusion, and of these, 58.3%(7) were amoebic. 100% were drained, of which 50% were by catheter with a diameter of 14Fr. Regarding the laboratory studies: 80%(16) of those with amoebic etiology had cultures of the abscess fluid without development, the leukocytes were 18.65 ± 6.55mm3 with a range of 16.5 in the amoebians vs. 14.58±6.51mm3 with a range of 17.6 in bacteria, Hb of 12.10±1.93 gr/dl in amoebians vs. 12.18 ± 1.72 gr/dl in bacteria and with procalcitonin of 18.06±12.77 gr/dl in amoebic vs. 19.98±59.76 gr/dl in bacterial. According to the imaging studies: the USG diameter was 10.67±2.78cm in amoebians vs. 10.53±4.91cm in bacteria and with a volume of 375.08±263.95 with a range of 782.0cm3 in amebic vs. 441.80±393.90 with a range of 1362.1cm3 in bacterial. Common etiologic agents for HA are E. histolytica (amoebic), bacterial (pyogenic), Mycobacterium tuberculosis, and various fungi. They tend to affect the younger population, especially men with immunosuppression, diabetes, and alcohol consumption. In developing countries, two-thirds are of amoebic origin and in need of puncture drainage. Our study observed that half had amoebic etiology corroborated by amoeba PCR, the majority unique, and almost all required drainage with diameters greater than 5cm by USG. In the present work, we can show that half of the patients diagnosed with a liver abscess in the Gastroenterology Service are of amoebic origin and have similar characteristics to those described in the international bibliography. The authors declare that there is no conflict of interest.

Sudden Death due to Spontaneous Rupture of Amoebic Liver Abscess: A case report

In the tropical countries about 5 % of the population infected with amoebiasis suffers from hepatic complications. However, in present era sudden deaths due to rupture of amebic liver abscess are rare in occurrence.

Abstract- Poster

Introduction:Chloroquine is one of the most used drugs in the world used for the prophylaxis and treatment of malaria and other clinical conditions.Case report:This index case with no psychiatric morbidity had presented with emergent mania following choloroquine use for amoebic liver abscess with dramatic resolution of symptoms following withdrawal of offending drug and short course of SDA.Discussion:About 10 case reports of chloroquine induced mania reported till date. Chloroquine has large volume of distribution of >100 L/kg leading to high tissue concentrations with brain concentrations 10–30 times higher than plasma. It is neurotoxic to dopamine neurons leading to hyperdopaminergic state. Also acts as NMDA agonist and GABA antagonist leading to excessive NMDA excitotoxicity with GABAergic inhibition. Treatment protocol includes withdrawal of drug, administration of antipsychotics and acidification of the urine to improve renal clearance.Conclusion:Chloroquine continues to be widely prescribed drug. It may be avoided if the patient has a psychiatric history. Knowledge of psychiatric side effects enables prompt detection and appropriate management.

Cerebellar ataxia: a rare toxicity of commonly used drug

Background and Aim: Metronidazole is commonly prescribed drug for amoebiasis and is usually well tolerated, and safe but can cause serious neurological adverse events including peripheral neuropathy which is relatively common but CNS toxicity is rare. We report a case of cerebellar ataxia who had taken metronidazole inadvertently for amoebic liver abscess.

Metronidazole-induced Cerebellar Neurotoxicity

Unintentional overuse of commonly prescribed medications can prove catastrophic. A 30-year-old man presented with difficulty in speaking and walking since 10 days. Examination revealed ataxic gait and bilateral cerebellar signs. During a recent admission for amoebic liver abscess, he was managed with the percutaneous aspiration of abscess and metronidazole which he continued for more than 2 weeks. During the current presentation, brain imaging showed confluent hypodensities in the bilateral dentate nucleus suggestive of metronidazole toxicity. Two weeks after discontinuation of the offending agent, the patient improved clinically with complete radiological resolution of lesions.

Caudate lobe amebic abscesses: percutaneous image-guided aspiration or drainage.

Amebic liver abscess is the most common type of liver abscess on a worldwide basis, with caudate lobe being a relatively uncommon location for its occurrence. Abscess in caudate lobe of liver is often considered a challenging location for image-guided percutaneous drainage due to its difficult-to-access location along with close relationship with major vessels at porta hepatis. This study aims to demonstrate safety and efficacy of percutaneous drainage for caudate lobe amebic abscess. In this retrospective study, hospital database was electronically searched for patients having caudate lobe amebic abscess that underwent percutaneous catheter drainage/needle aspiration (PCD/PNA) between January 2016 and January 2021. The etiology, risk factors, microbiology, complications, different approaches for PCD/PNA, and their outcome were studied and reported. Of 30 patients having caudate lobe amebic abscess treated with PCD/PNA, solitary caudate lobe abscess was seen in 29, whereas one patient had more than one abscesses in caudate lobe. Contained and free intraperitoneal rupture of the abscess were seen in 9 (30%) and one patient, respectively. Ten (32%) patients had associated vascular thrombosis, while 2 patients were found to have abscess-biliary communication. Twenty-six (86.7%) patients were treated with PCD, while remaining 4 (13.3%) with PNA. On Univariate analysis, factors such as volume, multilocularity, and contained rupture of the abscess were found to be significantly increasing the duration of percutaneous drainage (PCD), while only multilocularity (p value 0.007) continued to show statistical significance on Multivariate analysis. Venous thrombosis and duration of catheter drainage were the two factors found to have significant influence on the length of hospital stay on Univariate as well as Multivariate analysis (p value 0.05 and 0.001, respectively). The rates of catheter manipulation were also significantly higher in patients with abscess showing complex internal configuration (heteroechoic contents and/or multilocularity). Technical and clinical success rates of 100% and 96.7% were achieved through percutaneous interventions (PCD/PNA), despite the complex location of abscesses and associated complications, with no incidence of vascular injury. Liver abscess in caudate lobe can be accessed by different routes for percutaneous drainage, despite being surrounded by large vessels and its deep location, without major complications. Thus, PCD/PNA may be considered as a first-line therapy for the management of caudate lobe amebic abscesses in adjunct to medical therapy.

ArfX2 GTPase Regulates Trafficking From the Trans-Golgi to Lysosomes and Is Necessary for Liver Abscess Formation in the Protozoan Parasite Entamoeba histolytica.

Entamoeba histolytica is the causative agent of amoebic dysentery and liver abscess in humans. The parasitic lifestyle and the virulence of the protist require elaborate biological processes, including vesicular traffic and stress management against a variety of reactive oxygen and nitrogen species produced by the host immune response. Although the mechanisms for intracellular traffic of representative virulence factors have been investigated at molecular levels, it remains poorly understood whether and how intracellular traffic is involved in the defense against reactive oxygen and nitrogen species. Here, we demonstrate that EhArfX2, one of the Arf family of GTPases known to be involved in the regulation of vesicular traffic, was identified by comparative transcriptomic analysis of two isogenic strains: an animal-passaged highly virulent HM-1:IMSS Cl6 and in vitro maintained attenuated avirulent strain. EhArfX2 was identified as one of the most highly upregulated genes in the highly virulent strain. EhArfX2 was localized to small vesicle-like structures and largely colocalized with the marker for the trans-Golgi network SNARE, EhYkt6, but neither with the endoplasmic reticulum (ER)-resident chaperon, EhBip, nor the cis-Golgi SNARE, EhSed5, and Golgi-luminal galactosyl transferase, EhGalT. Expression of the dominant-active mutant form of EhArfX2 caused an increase in the number of lysosomes, while expression of the dominant-negative mutant led to a defect in lysosome formation and cysteine protease transport to lysosomes. Expression of the dominant-negative mutant in the virulent E. histolytica strain caused a reduction of the size of liver abscesses in a hamster model. This defect in liver abscess formation was likely at least partially attributed to reduced resistance to nitrosative, but not oxidative stress in vitro. These results showed that the EhArfX2-mediated traffic is necessary for the nitrosative stress response and virulence in the host.

From the Editor’s Desk...

From the Editor’s Desk...

The Consequence of COVID-19

SARS-CoV-2 is the third and largest pandemic that emerged in Wuhan city, Hubei province, China in 2019. As per WHO 45,988,595 people have been infected and the COVID 19 has caused more than 1,194,979 deaths. The clinical spectrum of COVID 19 varies from asymptomatic presentation to multi-organ dysfunction. The pathophysiology behind the sequel of COVID 19 immuno-suppression is an area yet to be explored. Here, we report a case of 52 year old male with persistent pyrexia post his recovery from COIVD-19. On further evaluation, a diagnosis of amoebic liver abscess that resulted as a sequel of COVID-19 was made.

Amoebic liver abscess in a COVID-19 patient: a case report

BackgroundAmoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA).Case presentationA 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement.ConclusionHere we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

English

BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children

Giant Amoebic Liver Abscess: A Rare Diagnosis in a Rural Setting of Sub-Saharan Africa.

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.

English

BACKGROUND Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. Diagnosis of liver abscess can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Children have unique set of predisposing causes for liver abscesses. The purpose of this study was to assess the clinical, demographic, and etiological profile of liver abscess in children between 1 month to 12 years of age. METHODS This is a prospective observational study conducted in the Department of Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt. of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi), Delhi from July 2016 to August 2017. All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children aged less than 7 years. Informed assent was taken from children aged more than 7 years, along with written and informed consent from their parents/guardians. Their clinical characteristics, radiological features and laboratory data were analysed. RESULTS Most common age group suffering from liver abscess was 5 - 10 years with male preponderance. Majority of the children belonged to lower socio-economic class and half of them were suffering from malnutrition. Most common clinical presentation of children suffering from liver abscess was fever with pain abdomen and tender hepatomegaly. Majority of the children had leucocytosis, high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Deranged liver function test with coagulopathy was noted in more than half of the children suffering from liver abscess. Commonest bacterial pathogen was methicillin resistant Staphylococcus aureus followed by Salmonella typhi, Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent causing liver abscess in children. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Most cases involve a single lesion on right lobe of the liver. Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the two most common pathogens. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children

Ultrasonographic evaluation of hepatobiliary diseases

Background and Objectives: The science of Diagnostic ultrasound is perhaps the most promising of the imaging modalities currently available. The main objective of this study is to establish the efficacy of ultrasonography to detect various hepatobiliary lesions and provide necessary information, aiding in their appropriate management. Methods: This study, carried over a period of two years, included 150 patients with various hepatobiliary lesions. There were patients of both sexes and their ages were above 5 years and below 85 years. After the routine blood and urine investigations and liver function tests, the patients were subjected to ultrasound examination. Results: One fifty cases, aged between 5 and 85 years, with various hepatobiliary lesions were studied with real time ultrasonography. The most frequently encountered Gall bladder lesion was Gallstones (44) with associated chronic cholecystits in 32 cases, acute cholecystitis in 10 cases, Gall bladder carcinoma in 2 cases. There were 3 cases of GB polyp, 2 case of chronic cholecystitis, 1 case of CA Gallbladder which were not associated with gall stones. Among the CBD lesions there were 2 cases of choledocholithiasis, 2 cases of cholangiocarcinoma and 1 case of choledochal cyst. The most frequently encountered focal liver lesion in this study was amoebic liver abscess which was found in 20 cases. The second most commonly encountered focal liver lesion was hepatocellular carcinoma which was found in 12 cases. 10 cases with hepatic metastasis were found. 4 cases with ultrasound features highly suggestive of haemangioma and 2 cases with hepatic hydatid disease were found. One case each of an intrahepatic haematoma and a simple liver cyst was found. Among the diffuse liver diseases, the most commonly encountered was fatty liver which was seen in 16 cases. The second most common diffuse liver disease was cirrhosis which was seen in 12 cases. 10 cases of acute hepatitis, 4 cases of chronic hepatitis and 3 cases of congestive liver was found. Conclusion: Ultrasound proved to be a sensitive, easily available and safe imaging modality for the diagnosis and follow-up of various hepatobiliary lesions and should therefore be the first line of investigation in suspected cases.

S2862 Budd-Chiari Syndrome Secondary to an Amebic Liver Abscess

S2862 Budd-Chiari Syndrome Secondary to an Amebic Liver Abscess

Enhanced Drainage Protocol in Large Amoebic Liver Abscess.

Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p -value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p -value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p -value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

HIF-1α modulates sex-specific Th17/Treg responses during hepatic amoebiasis

An invasive form of intestinal Entamoeba (E.) histolytica infection, which causes amoebic liver abscess, is more common in men than in women. Immunopathological mechanisms are responsible for the more severe outcome in males. Here, we used a mouse model of hepatic amoebiasis to investigate the contribution of hepatic hypoxia-inducible factor (HIF)-1α to T helper 17 (Th17)/regulatory T cell (Treg) responses in the context of the sex-specific outcome of liver damage. C57BL/6J mice were infected intrahepatically with E.histolytica trophozoites. HIF-1α expression was determined by qPCR, flow cytometry and immunohistochemistry. Tregs and Th17 cells were analysed by immunohistochemistry and flow cytometry. Finally, male and female hepatocyte-specific Hif1α knockout mice were generated, and the effect of HIF-1α on abscess development, the cytokine milieu, and Th17/Treg differentiation was examined. E.histolytica infection increased hepatic HIF-1α levels, along with the elevated frequencies of hepatic Th17 and Treg cells. While the Th17 cell population was larger in male mice, Tregs characterised by increased expression of Foxp3 in female mice. Male mice displayed increased IL-6 expression, contributing to immunopathology; this increase in IL-6 expression declined upon deletion of hepatic HIF-1α. In both sexes, hepatic deletion of HIF-1α reduced the Th17 cell frequency; however, the percentage of Tregs was reduced in female mice only. Hepatic HIF-1α modulates the sex-specific outcome of murine E.histolytica infection. Our results suggest that in male mice, Th17 cells can be modulated by hepatic HIF-1α via IL-6, indicating marked involvement in the immunopathology underlying abscess development. Strong expression of Foxp3 by hepatic Tregs from female mice suggests a potent immunosuppressive function, leading to initiation of liver regeneration. Infection with the parasite Entamoeba histolytica activates immunopathological mechanisms in male mice, which lead to liver abscesses that are larger than those in female mice. In the absence of the protein HIF-1α in hepatocytes, abscess formation is reduced; moreover, the sex difference in abscess size is abolished. These results suggest that HIF-1α modulates the immune response involved in the induction of immunopathology, resulting in differential disease susceptibility in males and females.

Clinical study of microbiological organisms causing liver abscess

Background: Liver abscess is a disease reported commonly in developing countries like India. It can be amoebic or pyogenic liver abscesses, the diagnosis of which is challenging to treating physicians. This clinical study was con-ducted to identify the common microbiological organisms causing liver abscess so that proper treatment can be administered.Methods: A prospective study was conducted in MGM Medical College and Hospital, Navi Mumbai for a period of 2 years in 50 patients diagnosed with liver abscess. Pus culture and blood culture were carried out in all patients and data recorded and analyzed for microbiological profile.Results: The pus and blood cultures were showing growth in 90% of the liver abscess patients. Klebseilla was the most common organism identified in liver abscess followed by Staphylococcus aureus.Conclusions: Most of the patients had polymicrobial organisms identified in the aspirate of which 29% were Klebseilla pneumoniae, the commonest organism.

A rare case of amoebic liver abscess as an immediate post-COVID-19 complication in an immunocompetent female: our experience from KIMS Secunderabad

The coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, the capital city of the Hubei Province, China, in late 2019. It was declared a pandemic by the World Health Organization on March 11th, 2020(1). COVID-19 has challenged healthcare systems through its highly infectious nature and case fatality rate. Till date, numerous complications of COVID-19 have been reported including post COVID-19 Lung fibrosis, pulmonary thromboembolism, lung abscess, complications involving other organs apart from respiratory system like Acute coronary syndromes, Takotsubo cardiomyopathy, peripheral thromboembolic events, large vessel strokes, vasculitis. Direct hepatic injury or hepatitis has also been reported. But there is sparsity of data on occurrence of liver abscess as an immediate post COVID 19 complication. Hence, we present this case of a middle-aged immunocompetent female to highlight the importance of considering rare complications in COVID 19 patients.