Experience with aspiration in cases of amebic liver abscess in an endemic area

Abstract

The study presented here was performed to evaluate the need for aspiration in patients with amebic liver abscess (ALA). Patients older than 12 years with a diagnosis of ALA based on clinical features, ultrasound results, and positive amebic serology were included in the study (n=144). Serological testing was performed to detect the presence of immunoglobin G antibody against Entamoeba histolytica, and a value of more than 0.4 optical density units was considered positive. All patients were given intravenous metronidazole (500 mg every 8 h) and their clinical progress and need for abscess aspiration was documented. Fever, pain in the upper abdomen, and tender hepatomegaly was seen in 133 (92.3%), 128 (88.8%), and 144 (100%) patients, respectively. Multiple abscesses were seen in 40 (27.7%) patients. Six (4.1%) patients died. Seventy-one (49.3%) patients responded to metronidazole alone. A total of 73 (50.69%) patients required aspiration of the abscess. This study shows that almost 50% of the patients with amebic liver abscess failed to respond to metronidazole and required aspiration.

Hyperbilirubinemia in Patients with Amoebic Liver Abscess: A Study of 75 Cases

“…In Group II patients, ALP value range from 78 to 868 units (mean=238.67 units) and ALP was raised in 42.3% patients (n=22) {p=0.000, statistically significant}. Earlier reports showed raised ALP in 76% cases of amebic liver abscess [9]. High ALP levels may be seen in 60-80% cases of amebic liver abscess.…”

An unusual presentation of amebic liver abscesses

“…Drainage catheters were initially placed because of concerns about abscess rupture; they were left in place after amebiasis was confirmed because of reports of enhanced recovery with decompression. 2,6 Our report illustrates that the diagnosis of amebic liver abscess can be challenging. E. histolytica can cause multiple liver abscesses without diarrhea, without a recent stay in a disease-endemic region and without an initial positive serologic test result.…”

“…1 However, the incidence of multiple lesions appears to be increasing, possibly owing to improved imaging modalities. 2,6 At the time of initial presentation, 70%-80% of patients have positive serum antibodies against E. histolytica antigens.…”

“…Drainage is also recommended for large abscesses in the left lobe of the liver (because of the risk of rupture into the pericardium) and for abscesses with imminent risk of rupture (> 300 cm 3 ). 1,2,6 Polymerase chain reaction testing of the aspirate can help establish the diagnosis. 9 In our patient, we initially suspected multiple pyogenic abscesses because of the clinical and radiological presentation.…”

Case report: Real-time contrast-enhanced ultrasonography for the diagnosis of typical ‘bull's eye’ sign of hepatic abscess caused by Acinetobacter baumannii in a tumor patient

“…Ultrasonic imaging using microbubble contrast agents enhances the ultrasound backscatter, reflection of the ultrasound waves, in order to produce a sonogram with increased contrast due to the increased echogenicity difference (6)(7)(8). Once diagnosed, patients with hepatic abscesses typically recover following conservative surgical treatment or anti-inflammatory drainage therapy, and the characteristic ̔bull's eye̓ sign in the liver gradually disappears (9,10).…”