A Review of Amoebic Liver Abscess for Clinicians in a Nonendemic Setting

Abstract

Amoebic liver abscess (ALA) is an uncommon but potentially life-threatening complication of infection with the protozoan parasite Entamoeba histolytica. E histolytica is widely distributed throughout the tropics and subtropics, causing up to 40 million infections annually. The parasite is transmitted via the fecal-oral route, and once it establishes itself in the colon, it has the propensity to invade the mucosa, leading to ulceration and colitis, and to disseminate to distant extraintestinal sites, the most common of which is the liver. The authors provide a topical review of ALA and summarize clinical data from a series of 29 patients with ALA presenting to seven hospitals in Toronto, Ontario, a nonendemic setting, over 30 years.

Burden of Liver Abscess and Survival Risk Score in Thailand: A Population-Based Study

“…8 ALA is widely distributed throughout the tropics and subtropics, causing up to 40 million infections annually. 9 The extent of liver abscess has remained unclear because of the lack of a population-based study. A recent previous report in Taiwan showed that PLA was endemic and that some factors including diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease.…”

Is procalcitonin increased in cases of invasive amoebiasis? A retrospective, observational study

“…It was therefore surprising to note that liver enzyme assays did not show any major variation in the study group and were globally in accordance with a cholestasis syndrome. These markers have scarcely been reported in previous amoebic disease studies (Wuerz et al, 2012). The results concerning α-2-macroglobulin were more questionable, since this biomarker is usually implicated in the regulation of liver fibrosis mechanisms.…”

“…Significant immigration flows and frequent foreign travel mean that the biological diagnosis of this condition has become an important concern in healthcare centres. Biochemical and cytological biomarkers have been uninformative thus far (Stanley, 2003;Wuerz et al, 2012), and serological tests are not compatible with an emergency context. Practitioners need tests that are quick and easy to perform, in order to guide the aetiological diagnosis in cases of strong presumption.…”

“…Very few alternative biomarkers are currently available for predicting the invasiveness of amoebiasis, and those that are in use are not specific. For instance, hyperneutrophilia is inconsistent; there is no hypereosinophilia in invasive amoebiasis (Stanley, 2003;Wuerz et al, 2012); and liver enzymes show variable blood levels, with no major increase (Wuerz et al, 2012). These limitations may delay the initiation of effective treatment; hence, additional biomarkers that indicate invasive amoebiasis are needed.…”

Supra-Infected Hepatic and Renal Amebic Abscesses-A Case Report

“…It is most prevalent in developing countries and tropical areas with poor sanitary conditions due to its fecal oral spread. Risk factors also include recent travel to endemic areas, poor hygiene, low socioeconomic status and institutionalization [2].…”