Introduction
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.
Causes of amoebic liver abscess
Amoebic liver abscess is caused by Entamoeba histolytica
Symptoms of amoebic liver abscess
The following are the symptoms of ALA:
- 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 of amoebic liver abscess
The signs of amoebic liver abscess include the following:
- 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 for amoebic liver abscess
Objectives
The treatment objectives of amoebic LA are:
- 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.