Amebic liver abscess: Clinico-radiological findings and interventional management

Abstract

In its classic form, amebic liver abscess (ALA) is a mild disease, which responds dramatically to antibiotics and rarely requires drainage. However, the two other forms of the disease, i.e. , acute aggressive and chronic indolent usually require drainage. These forms of ALA are frequently reported in endemic areas. The acute aggressive disease is particularly associated with serious complications, such as ruptures, secondary infections, and biliary communications. Laboratory parameters are deranged, with signs of organ failure often present. This form of disease is also associated with a high mortality rate, and early drainage is often required to control the disease severity. In the chronic form, the disease is characterized by low-grade symptoms, mainly pain in the right upper quadrant. Ultrasound and computed tomography (CT) play an important role not only in the diagnosis but also in the assessment of disease severity and identification of the associated complications. Recently, it has been shown that CT imaging morphology can be classified into three patterns, which seem to correlate with the clinical subtypes. Each pattern depicts its own set of distinctive imaging features. In this review, we briefly outline the clinical and imaging features of the three distinct forms of ALA, and discuss the role of percutaneous drainage in the management of ALA.

Amebic liver abscess: An update

“…In a large study including over 2000 ALA patients, adult males between ages 30 and 50 years had the highest incidence of ALA[ 21 ]. This pronounced predilection for gender and age is thought to be due to the effect of testosterone and alcohol consumption[ 1 , 2 , 22 , 23 ]. Early cytokines production by natural killer T (NKT) cells, particularly Interferon (IFN) γ, plays a major role in EH invasion[ 24 ].…”

“…At the time of diagnosis, less than one-third of the patients have diarrhea, only about 10% of patients have jaundice, and 5%-14% of cases have pulmonary symptoms like chest pain and shortness of breath. Recently, three distinct clinical presentations of ALA have been described according to the severity and duration of symptoms[ 22 , 32 ]. These include: (1) Acute aggressive ALA - characterized by acute onset of severe symptoms, systemic toxicity, markedly deranged laboratory parameters, and high risk of rupture requiring a drainage procedure; (2) subacute mild ALA - characterized by mild-to-moderate symptoms with onset within 2-4 wk, usually responding to the medical therapy; and (3) chronic indolent ALA - characterized by late presentation (> 4 wk) with mild persistent symptoms including pain in abdomen.…”

“…Patients with complicated ALA have variable presentations depending upon the nature and severity of complications. Most complications of ALA are related to its rupture into the adjacent structures, vascular thrombosis or compression, and secondary bacterial infection[ 22 ].…”

“…The incidence of ALA rupture varies from 6% to 40%[ 22 ]. In terms of the sites of rupture, the intraperitoneal site currently predominates over pleuropulmonary rupture (10%-24% vs 4.2%-7%)[ 33 , 34 ].…”

A Rare Case of Charcot-Leyden Crystals In liver biopsy in a 14-Year-Old Boy with Persistent Fever and Miliary Infiltrates

“…A long-standing high eosinophil count is a diagnostic feature [5]. Amoebic liver abscesses typically present with symptoms such as fever, chills, abdominal pain, nausea, and vomiting [6]. Hydatid disease can lead to the formation of multiple cysts in the liver, which can cause symptoms such as abdominal pain, hepatomegaly, and jaundice [7].…”