Amoebic liver abscess - liver disease

Amoebic liver abscess

Definition

Infection of the liver by Entamoeba histolytica.

Aetiology/pathophysiology

E. histolytica is a protozoan that infects the large intestine. The infection water is food borne and is most common in parts of the world with poor sanitation, e.g. Far East and Africa. Ingestion of the cysts results in the release of trophozoites in the intestine, which are thought to invade through the mucosa gaining entry to the portal blood system and then spread to the liver.

Clinical features

The onset of symptoms may be sudden or insidious. Symptoms include right upper quadrant pain, anorexia, nausea, weight loss and night sweats. Tender hepatic enlargement without jaundice is usual. Basal pulmonary collapse and pleural effusion may occur.

Complications

Rupture, secondary infection and septicaemia. Metastatic brain abscesses have been reported.

Investigations

Ultrasound or CT of the abdomen can show the abscess. Blood tests include blood culture and serological tests. Guided aspiration and stool ova, cyst and parasite examination may demonstrate the organism.

Management

Treated with metronidazole. Percutaneous aspiration is used in resistant cases.