Amoebic Liver Abscess

exp date isn't null, but text field is

Amoebic liver abscess is a collection of typically brownish coloured fluid in the liver, occurring often as a single mass in the right lobe and a complication of intestinal infection with Entamoeba histolytica. Lung, heart and brain infections are uncommon sequelae. Occasionally, pyogenic abscesses may have a similar clinical presentation.

Treatment of amoebic abscesses should be initiated with a tissue agent active against the trophozoite form followed by a luminal agent to eliminate intra-luminal cysts.

Cause

  • Entamoeba histolytica

Symptoms

  • Right upper abdominal pain referable to the epigastrium, right chest or right shoulder
  • Fever
  • Malaise
  • Sweats
  • Cough
  • Hiccups
  • Anorexia
  • Weight loss
  • Jaundice (uncommon)
  • Concurrent diarrhoea (less than one-third of patients)

Signs

  • Large tender liver
  • Tenderness and/or bulging at right intercostal spaces
  • Jaundice
  • Dullness to percussion on the right lower chest zones with basal crepitations
  • Amoebic empyema following extension into the chest cavity
  • Peritonitis (uncommon)

Investigations

  • Abdominal ultrasound
  • Chest X-ray
  • FBC
  • ESR
  • Stool examination
  • Abdominal CT scan
  • Serology (amoebic antibodies)

Treatment Treatment Objectives

  • To eradicate Entamoeba histolytica infection
  • To prevent further destruction of liver tissue
  • To prevent further complications (e.g. rupture of abscess into pleural, pericardial or peritoneal space)

Non-pharmacological treatment

  • Therapeutic aspiration may be required in patients with poor response to therapy

Pharmacological Treatment

1st Line Treatment Evidence Rating: [A]

  • Metronidazole, oral,

Adults

800 mg 8 hourly for 10 days (tissue agent)

Children

15 mg/kg 8 hourly for 10 days (tissue agent)

Then
  • Diloxanide furoate, oral,

Adults

500 mg 8 hourly for 10 days (luminal agent)

Children

6-8 mg/kg 8 hourly for 10 days (luminal agent)

2nd Line Treatment

Evidence Rating: [A]

  • Tinidazole, oral,

Adults

2 g once daily for 5 days (tissue agent)

Children

>3 years; 50 mg/kg (max. 2 g) once daily for 5 days (tissue agent)

Then

  • Paromomycin, oral,

Adults

8-10 mg/kg 8 hourly for 7 days (luminal agent)

Children

8-10 mg/kg 8 hourly for 7 days (luminal agent)

Referral Criteria

Patients with abscesses that are large or not responding to treatment will need to be referred to a specialist.