A CASE OF MULTIPLE AMOEBIC LIVER ABSCESSES: CLINICAL IMPROVEMENT AFTER PERCUTANEOUS ASPIRATION

Abstract Amoebic liver abscesses are by far the most common extra-intestinal manifestation of invasive amoebiasis. The classical clinical picture consists of fever, right upper quadrant pain and hepatomegaly. Ultrasound and serology make an early diagnosis possible. Amoebic liver abscesses usually appear singly and are normally situated in the right lobe of the liver. This case report refers to a white Belgian woman, living in an endemic area for amoebiasis, presenting with 25 amoebic liver abscesses, who did not improve clinically despite appropriate anti-amoebic therapy, is described. Only percutaneous drainage of the larger abscesses led to clinical recovery. Amoebic abscess aspiration and evacuation under ultrasonographic guidance is of limited risk, but in experienced hands may enhance clinical recovery, particularly in patients with large abscesses not responding to conservative medical treatment. Aspiration of large abscesses (> 5 cm) is rarely necessary but should be considered if there is no clinical improvement after 3 days of nitroimidazole treatment with amoebicides.

[1]  E. Tannich,et al.  Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound‐guided needle aspiration: a comparative, prospective and randomized study , 2003, Tropical medicine & international health : TM & IH.

[2]  W. Petri,et al.  Laboratory Diagnosis of Amebiasis , 2003, Clinical Microbiology Reviews.

[3]  T. Madiba,et al.  Amoebic liver abscess--results of a conservative management policy. , 2003, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[4]  E. Tannich,et al.  Treatment of asymptomatic intestinal Entamoeba histolytica infection. , 2002, The New England journal of medicine.

[5]  R. Jankiewicz.  Clinical Manifestations and Ultrasonography Guided Aspiration of Amoebic Liver Abscesses in St Walburg's Hospital, Nyangao, Tanzania , 2002, Tropical doctor.

[6]  A. Verghese,et al.  Amebic liver abscesses masquerading as pyemic abscesses. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  K. Kain,et al.  Entamoeba histolytica and Entamoeba dispar: epidemiology and comparison of diagnostic methods in a setting of nonendemicity. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  D. Rockey,et al.  Amebic liver abscess: epidemiology, clinical features, and outcome. , 1999, The Western journal of medicine.

[9]  R. Davidson,et al.  Do amoebic liver abscesses start as large lesions? Case report of an evolving amoebic liver abscess. , 1998, The Journal of infection.

[10]  T. Jackson.  Entamoeba histolytica and Entamoeba dispar are distinct species; clinical, epidemiological and serological evidence. , 1998, International journal for parasitology.

[11]  Jian-Xing Wu,et al.  Perforated Amebic Liver Abscess: Clinical Analysis of 110 Cases , 1994, Southern medical journal.

[12]  J. Aucott,et al.  Amebiasis and "nonpathogenic" intestinal protozoa. , 1993, Infectious disease clinics of North America.

[13]  C. Clark,et al.  A Redescription of Entamoeba Histolytica Schaudinn, 1903 (Emended Walker, 1911) Separating It From Entamoeba Dispar Brumpt, 1925 1 , 1993, The Journal of eukaryotic microbiology.

[14]  A. Simjee,et al.  Asymptomatic intestinal colonization by pathogenic Entamoeba histolytica in amebic liver abscess: prevalence, response to therapy, and pathogenic potential. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  R. Dhiman,et al.  Percutaneous catheter drainage of amoebic liver abscess. , 1992, Clinical radiology.

[16]  G. Maltz,et al.  Amebic liver abscess: a 15-year experience. , 1991, The American journal of gastroenterology.

[17]  A. Akamaguna,et al.  Amoebic liver abscess: the effect of aspiration on the resolution or healing time. , 1990, Annals of tropical medicine and parasitology.

[18]  S. K. Acharya,et al.  Needle aspiration of amoebic liver abscess. , 1989, BMJ.

[19]  J. Ravdin,et al.  In vitro susceptibilities of Entamoeba histolytica to azithromycin, CP-63,956, erythromycin, and metronidazole , 1989, Antimicrobial Agents and Chemotherapy.

[20]  A. Simjee,et al.  Indications for aspiration of amoebic liver abscess. , 1989, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[21]  J. Ravdin,et al.  The interaction of human neutrophils and Entamoeba histolytica increases cytopathogenicity for liver cell monolayers. , 1986, The Journal of infectious diseases.

[22]  H. Schiffman,et al.  Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage. , 1985, Radiology.

[23]  S. Looareesuwan,et al.  Low dose tinidazole in the treatment of amoebic liver abscess. , 1985, The Southeast Asian journal of tropical medicine and public health.

[24]  A. Simjee,et al.  Serial ultrasound in amoebic liver abscess. , 1985, Clinical radiology.

[25]  J. Knobloch,et al.  Development and persistence of antibodies to Entamoeba histolytica in patients with amebic liver abscess. Analysis of 216 cases. , 1983, The American journal of tropical medicine and hygiene.

[26]  R. Lasserre,et al.  Single-day drug treatment of amebic liver abscess. , 1983, The American journal of tropical medicine and hygiene.

[27]  D. Katzenstein,et al.  New Concepts of Amebic Liver Abscess Derived from Hepatic Imaging, Serodiagnosis, and Hepatic Enzymes in 67 Consecutive Cases in San Diego , 1982, Medicine.

[28]  Adams Eb,et al.  Ii. Amebic Liver Abscess and its Complications , 1977 .