Cases Of Amoebic Liver Abscess Research Articles

Correlation of amoebic liver abscess with computed tomography findings in a tertiary care centre

Aim: The purpose of the present research was to co-relate the clinical findings of amoebic liver abscess cases in tertiary care centre with the respective computed tomographic findings. Methodology: CT images of 112 symptomatic patients with ALA were analysed to identify the imaging features distinctive of each morphological type. The following CT findings were investigated: the presence of abscess wall, rim enhancement, edge characteristic, septa, intermediate density zone, and peripheral hypodensity. Abscesses from each type were further evaluated for their clinical presentations, laboratory findings and outcomes. Results: We identified three types of ALAs: type I, II and III. Type I abscesses (66%) were characterized by absent or incomplete walls, ragged edges and peripheral septa; their edges exhibited irregular and interrupted enhancement. Type II (28%) had a complete wall characterized by rim enhancement and peripheral hypodense halo. Type III (6%) demonstrated a wall but without enhancement. Clinically, type I abscesses presented acutely with severe disease. They had significantly deranged laboratory parameters, higher incidence of rupture and higher rate of inpatient or intensive care unit admission. The severity of the disease prompted immediate percutaneous drainage in most type I abscesses (81%).

A rare case of amoebic liver abscess with caecal perforation

Amoebic colitis is one of common infection in all groups of people in almost all geographical areas. Routinely it is easily treatable disease, but it can get complicated and then prognosis is poor. Amoebic liver abscess is a common complication of amoebiasis but along with caecal perforation it carries worst prognosis.

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.

A RARE CASE OF COMPLICATED LIVER ABSCESS WITH MIDDLE HEPATIC VEIN THROMBOSIS: A CASE REPORT AND REVIEW OF LITERATURE

In developing countries Amoebic liver abscess is commonly encountered disease and it’s also the commonest extraintestinal manifestation of Entamoeba histolytica infection. Usual complication of Amoebic liver abscess arises due to collection of pus in various cavities, like in peritoneal cavity following perforation, in the pleural cavity which is known as empyema thoracis, and rarely it is complicated by life threatening conditions such as venous extension of the disease involving the hepatic veins and IVC, with only few cases reported. Here we describe a case of amoebic liver abscess extending across middle hepatic vein.

A case of amoebic liver abscess complicated by bilhaemia and venous thrombosis

Amoebic liver abscess is the most common extra-intestinal manifestation of amoebiasis. It usually responds well to treatment with metronidazole together with drainage, if indicated. Uncommonly, the abscess may rupture into the pleura, peritoneum or pericardium, bile duct at its hilum, or produce septic emboli. We present a patient with two rare complications: venous thrombosis and jaundice secondary to bilhaemia.

Amoebic liver abscess with lung involvement in paediatric

Background: There are few reports of amoebic liver abscess in children, and the disease is life-threatening. It can rupture into the pleura to cause acute respiratory distress. Pulmonary amoebiasis, the second most common extra-intestinal pattern of infection, is frequently associated with amoebic liver abscesses. Case Description: We reported a case of amoebic liver abscess with lung involvement in a 10 y old Malaysian boy who presented with prolonged fever, lethargy, diarrhea, and right hypochondriac pain. He was diagnosed with possible ruptured liver abscess. Intravenous Ceftriaxone and Metronidazole were commenced. No organism was isolated in Blood culture, and stool microscopic examination for ova and cyst was negative. Ultrasonography of abdomen revealed of peritoneal collection with amoebic liver abscess in the superolateral segment of right lobe of liver whereas ultrasonography of thoracic showed pleural effusion and collapsed consolidation of right lower lobe of lung. After two days of admission, he developed acute respiratory distress Abdominal and chest drainage were done. Pleural fluid microscopic examination revealed Trophozoite of Entamoeba histolytica. Patient responded well clinically after completed four ws of treatment of Metronidazole. Discussion: The role of microscopic stool examination is limited. In this case, only one sample of stool was sent, and a microscopic stool examination of the cyst was negative. In view of the difficulty in demonstrating the causative pathogen in a clinical specimen, serological methods play an important role in diagnosing amoebic liver abscess. If the patient had undergone drainage of the abscess surgically, the aspiration material could be sent for microscopic examination. In this case, the microscopic examination of pleural fluid revealed the trophozoite of Entamoeba histolytica. Ultrasonography is easy and very useful in making early diagnosis and treatment. Most uncomplicated amoebic liver abscesses can be treated successfully with amoebicidal drug therapy alone. However, such in this case, ruptured amoebic liver abscess with lung involvement, surgical drainage is needed. In this case, the patient was responded well after four ws of treatment of Metronidazole. Conclusion: A multidisciplinary approach, including a gastroenterologist, radiologist, surgeon, and laboratory, is crucial for early diagnosis and successful treatment of these curable infections to prevent further complications, which can compromise the patient's outcome.

Clinical profile of amoebic liver abscess cases: A descriptive study from Pondicherry

Clinical profile of amoebic liver abscess cases: A descriptive study from Pondicherry

Effective treatment options in amoebic liver abscess in a tertiary care setting in West Bengal: an observational study, India

Background: Conservative management and image guided drainage have emerged as mainstay of the treatment in Amoebic Liver Abscess (ALA), with surgery used in complicated cases. The current study was conducted with an objective to demonstrate the effectiveness of the different treatment options in ALA.Methods: An observational study was conducted on 100 patients, aged 19 to 60 years, admitted with sonographic evidence of Amoebic Liver Abscess (ALA) in the General Surgery wards of a tertiary care hospital in Kolkata. Patients coming for regular follow-up after completing treatment were included. On completion of the treatment before discharge a repeat ultrasonography of the upper abdomen was done to confirm remission.Results: Majority of the patients were male, Muslim, rural resident and within 30 – 40 years age. Chief complaints were pain (100%), fever (60%) and abdominal swelling (80%). Tender hepatomegaly (80%) and icterus (36%) were present. Majority patients had the left lobe of the liver affected (72%) and abscess dimension <6 cms (66.67%). Out of the participants with unruptured abscess 21.87% had multiple abscesses. Out of 64 patients subjected to conservative therapy, 44 were successfully managed. Success rate of 72.73% was observed among 44 patients receiving ultrasound guided needle aspiration. All twenty patients subjected for pigtail catheter drainage were cured. Four patients underwent laparotomy and open drainage following intraperitoneal rupture.Conclusions: Conservative treatment was observed to be sufficient in majority of cases of amoebic liver abscess of lesser size with percutaneous catheter drainage useful in large abscess. Surgical intervention was required in ruptured or complicated abscesses.

A 63-year-old man with invasive amoebiasis mimicking pulmonary tuberculosis

Entamoeba histolytica is an intestinal protozoan parasite transmitted through the faecal–oral route. Up to 90% of E. histolytica infections are asymptomatic or associated with mild symptoms. Most cases in Canada are from residents of or travellers from areas of high endemicity, although autochthonous cases have been reported among men who have sex with men (MSM) and Canadian Indigenous populations. We present an uncommon case of amoebic liver abscess with diaphragmatic perforation and intrapulmonary extension mimicking active pulmonary tuberculosis. Amoebic liver abscesses are infrequently seen outside of endemic areas, rarely extend outside the liver, and should be suspected in cases of unexplained fever even in the absence of signs, symptoms, or basic blood tests suggestive of liver pathology.

A prospective study of one hundred cases of Amoebic liver abscess in a secondary care hospital of Delhi

A prospective study of one hundred cases of Amoebic liver abscess in a secondary care hospital of Delhi

Indirect Haemagglutination Test in Comparison with ELISA for Detection of Antibodies against Invasive Amoebiasis.

Diagnosis of amoebiasis is based on combination of tests like microscopy, imaging, serology and molecular methods. In absence of molecular techniques, serology can be used as an alternative aid. Various serological techniques were reported with different sensitivity and specificity. The diagnostic efficiency of these assays mainly depends on the characteristics of antigen that is being used and various conditions of performance. To evaluate the efficiency of recombinant calcium binding domain containing protein by Indirect Haemagglutination Assay (IHA) against a commercial ELISA among amoebic liver abscess cases and control group. The study was carried out during the period of 2011-2015 and blood samples were collected from suspected amoebiasis cases who were attending the clinics of Medicine and Paediatrics department, JIPMER. A total of 200 sera samples which included 100 Amoebic Liver Abscess (ALA), 50 cases of other parasitic infections and liver diseases and 50 presumed healthy controls were examined by IHA and commercial ELISA. In brief, chick cells were stabilized by Double Aldehyde Sensitization (DAS) method. Optimum Sensitizing Dose (OSD) of the antigen was determined. The test was performed in a U-bottomed microtiter plate with recombinant amoebic antigen (12.5μg/ml), incubated at Room Temperature (RT) for 2 hours. RIDASCREEN Entamoeba IgG ELISA kit which is commercially available was used to evaluate the samples as per manufacturer's instruction. The overall sensitivity and specificity of the IHA was 62% and 96%, respectively when compared to ELISA having sensitivity and specificity of 69% and 90%, respectively. The positive predictive value of the IHA was 91% while negative predictive value was 79%. Similarly, the positive predictive value of the ELISA was 87% while negative predictive value was 74%. As serology heavily suffers due to lack of a standardised test system employing the native antigen, there arises need to identify alternative source of recombinant antigen which could effectively improvise the existing lacunae in the current system. Serology acts as an adjunct in clinical decision making if properly interpreted. This is an important consideration in endemic region where health services resources are limited.

Fatal case of amoebic liver abscess in a child.

We reported a case of amoebic liver abscess (ALA) in a 6-year-old Malaysian boy who presented with fever, lethargy, diarrhoea and right hypochondriac pain. On admission he was diagnosed with perforated acute appendicitis and a laparotomy was done. After surgery he developed acute respiratory distress. Ultrasonography, chest X-Ray and CT scan revealed two ALAs in the posterior segment of right lobe of liver, pleural effusion and collapsed consolidation of lungs bilaterally. Percutaneous liver abscesses drainage was done and intravenous Metronidazole was started. PCR carried out on the pus from the abscess was positive for Entamoeba histolytica. Patient however succumbed to the infection one week after admission.

Amoebic liver abscess: Drained by ultrasound guided percutaneous aspiration

Summary : Amoebic Liver Abscess in a 20-month-old child: A case of amoebic liver abscess in a Nigerian child is presented. Management consisted of 10days course of Metronidazole and 5days course of Tinidazole without improvement. This was followed by four sessions of ultrasound guided percutaneous needle aspirations over a period of 4 weeks with subsequent resolution and recovery. This high lights another method of dealing with difficult cases of amoebic liver abscess that may be employed when necessary.

Biliary Fistula Treated with Endoscopic Therapy in Amoebic Liver Abscess with Cirrhosis

Large amoebic liver abscess is treated with either needle aspiration or percutaneous catheter drainage. Biliary communication of amoebic liver abscess has been reported in up to 27% of cases. Biliary fistula suspected by presence of bile in percutaneous draining catheter and confirmed by endoscopic retrograde cholangiopancreatography. Endoscopic therapy with sphincterotomy and biliary stent placement appears to be an effective mode of treatment for biliary fistulas complicating liver abscesses. Liver abscess is rare in cirrhosis. Here we are reporting a case of amoebic liver abscess with biliary fistula in a chronic liver disease patient which was managed with biliary sphincterotomy and biliary stent placement. A 45 Year old male alcoholic presented with fever of 1 week duration, right hypochondriac pain, abdominal distention and breathlessness. Abdominal examination revealed tenderness over the intercostal region and right hypochondriac area with mild ascites and right-sided pleural effusion. Investigations revealed neutrophilic leukocytosis (43,900cells/mm3) with elevated liver enzymes (SGOT: 102 U/L, SGPT: 169 U/L), alkaline phosphatase (649 U/L), ultrasound abdomen suggestive of coarsened echo texture of liver with surface irregularity and also liver abscess of size about 9.8 × 8.7 cms in segment VII of liver. He was also incidentally detected HBsAg positive. Ascitic fluid analysis suggestive of high SAAG, culture showed no growth of organisms. Blood culture was sterile. Hence diagnosed as cirrhosis with liver abscess. Patient was started on intravenous metronidazole and pipercillin and tazobactum. In view of large abscess and persistent symptoms percutaneous pigtail catheter placed into the liver abscess, anchovy sauce colored pus drained out. After few days of pigtail placement, bile was draining out of the catheter. Suspected biliary fistula, tubogram revealed communication between abscess and biliary radicles. Patient was treated conservatively for 1 month, but still bile was draining out of the catheter. Biliary sphincterotomy done and common bile duct stent was placed. Drain from percutaneous catheter decreased <10 ml per day and percutaneous catheter removed. Patient was doing well and discharged. Follow up did not show any recurrence of abscess.

C型慢性肝炎に対する3剤併用治療中に発症したアメーバ性肝膿瘍の1例

症例は58歳の男性．1型，高ウイルス量のC型慢性肝炎に対し，3剤併用療法を開始した．投与1カ月後にはHCVRNAは検出されず，副作用もなく経過していたが，投与開始約4カ月目に食思不振，発熱，右季肋部痛が出現した．白血球数9,100/μl，CRP 15.17 mg/dlと炎症所見を呈し，超音波検査，断層撮影検査にて多発性の肝膿瘍を認めた．細菌性肝膿瘍を疑い，抗生剤の投与を開始したが，解熱は得られず，肝膿瘍は増大し，一部は腹腔へ膨出した．入院時の血清アメーバ抗体価が高値を示し，肝膿瘍の穿刺内容液は粘稠で白色～薄黄緑色のクリーム状を呈した．穿刺内容液中に赤痢アメーバ虫体を確認し，アメーバ性肝膿瘍と診断した．メトロニダゾールの投与ならびに経皮的ドレナージにて速やかな解熱，膿瘍の縮小が得られた．患者は3剤併用治療の開始5カ月前に原因不明の下痢を来し，大腸内視鏡検査にて大腸に多発するアフタ性病変が認められていたことが後に判明した．遡及的診断ではアメーバ腸炎と考えられたが，感染経路は不明であった．C型慢性肝炎に対する3剤併用療法時の併発感染症疾患のひとつとしてアメーバ性肝膿瘍も念頭に置く必要がある．アメーバ性肝膿瘍の迅速な診断，問診の重要性があらためて認識された．

Unique short tandem repeat nucleotide sequences in Entamoeba histolytica isolates from China

A few PCR-based DNA typing methods using repetitive elements contained within both protein-coding genes and noncoding DNAs have been reported for Entamoeba histolytica over the years. The serine-rich E. histolytica protein and tRNA-linked short tandem repeats (STRs) are most commonly used to investigate the relationship between parasite genotype and E. histolytica infection outcome. Many E. histolytica infections in China have been reported; however, little genome information has been provided. In the current paper, five Chinese E. histolytica samples were reported: three amoebic liver abscess cases, one combined case and one asymptomatic case. Our study is the first to report on the DNA typing information of E. histolytica in China. We included two city, one imported, and two country cases. Sequence analysis of serine-rich protein genes confirmed the presence of seven sequence types in five isolates. The STRs amplified from the samples revealed five STR variations in the A-L, four in the N-K2, and R-R loci, three in D-A, S(TGA)-D and S-Q loci. Two country patients were found to have a different outcome of infection with the same genotypes of E. histolytica, whereas in a city case, one E. histolytica strain had led to different outcome of the infection in one patient. Analyses of the results suggest that more genome information of E. histolytica strains from China through accurate methods is needed to interpret how the parasite genome plays a role in determining the outcome of E. histolytica infections.

SP6-3 Fermented sap of spiky Palmyra toddy (borassus flabellifer) suggested as a vehicle of transportation of amoebiasis in the district of mannar, Sri Lanka: 50 cases of amoebic liver abscess within 15 months

IntroductionHepatic abscess is the commonest extraintestinal manifestation of Entamoeba histolytica, the agent of amoebiasis. Mannar is a district of Northern Province in Sri Lanka where resettlement is in progress, following...

Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.

A case of amoebic liver abscess complicated by a gastric fistula cured with oral medication only

A case of amoebic liver abscess complicated by a gastric fistula cured with oral medication only

Amoebic liver abscess in the medical emergency of a North Indian hospital

BackgroundAmoebic Liver abscess although fairly common in developing countries, yet, there is limited data on the clinical presentation to the emergency department. A retrospective analysis of 86 indoor cases of Amoebic Liver Abscess presenting to the emergency department over a 5-year period was carried out.FindingsThe mean age of patients was 40.5 ± 2.1 years (male-female ratio = 7:1). Fever, pain abdomen and diarrhea were seen in 94%, 90% and 10.5% respectively. Duration of symptoms less than 2 weeks was seen in 48% cases. Hepatomegaly was present in 16% cases only, a right sided pleural effusion in 14% cases and ascites in 5.7%. On ultrasound, a right lobe abscess was seen in 65%, a left lobe abscess in 13% and multiple abscesses in both the lobes in 22% cases. Seventy one cases underwent per-cutaneous pigtail catheter drainage for a mean period of 13.4 ± 0.8 days. The mortality rate was 5.8%. On multivariate regression and correlation analysis, a higher number of inserted pigtail catheters correlated to mortality.ConclusionsAmoebic liver abscess presents commonly to the emergency department and should be suspected in persons with prolonged fever and pain abdomen. Conservative management for uncomplicated amoebic liver abscess and insertion of single per-cutaneous pigtail catheter drainage for complicated amoebic liver abscess are efficacious as treatment modalities.