Amoebic Liver Abscess (ALA)

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Amoebic liver abscess is the most frequent extraintestinal manifestation of Entamoeba histolytica infection

Cause

• Entamoeba histolytica

Signs and symptoms

• Right upper abdominal pain
• Abdominal distension
• Fever
• Cough
• Large tender liver
• Tenderness and/or bulging at right intercostal spaces
• Jaundice
• Dullness to percussion on the right lower zones with right basal crepitation

Investigations

• Stool microscopy for cysts and motile organisms
• Abdominal ultrasound scan
• Chest radiograph
• Liver function tests

Treatment objectives

• To eradicate infection
• To prevent further destruction of liver tissue
• To prevent rupture of abscess into pleural, pericardial or peritoneal space
• To prevent sepsis
• To prevent death

Non-pharmacological treatment

• Therapeutic aspiration of abscess - if large, or when pharmacological therapy fails (for experts only)

Pharmacological treatment

Metronidazole oral

Adults:

800mg orally every 8 hours for 10 days

Child:

10mg/kg (maximum 250mg) orally every 8 hours for 10 days

OR

Tinidazole, oral

Adult: 2g once daily for 3 days (with food)

Child: 50-60mg/kg daily for 5 days (with food)

FOLLOWED BY:

A luminal amoebicidal agent to eradicate the intestinal carriage:

Diloxanide furoate oral

Adult:

500mg orally every 8 hours for 10 days.

Child:

6–7mg/kg (maximum 500mg) orally every 8 hours for 10 days

Prevention

• Avoid eating unpeeled fruits or uncooked vegetables have a potential risk of contamination by Entamoeba histolyticacysts in endemic regions
• In areas with high concentration of amoeba, water should be boiled before use as chlorinated water may not adequately prevent infection.

Referral

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