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[Amebic liver abscess--personal observations]
J Niścigorska1, A Boroń-Kaczmarska
1Katedra i Klinika Chorób Zakaźnych PAM w Szczecinie.
Abstract:
In the period of 1989-1995 seven patients with amebic liver abscess were observed in Clinic of Infectious Diseases of Pomeranian Medical School in Szczecin. The diagnosis has been made on the base of epidemiological data, presence of intrahepatic defect by a scanning procedure of liver (ultrasonography, CT, scintigraphy) and positive serologic test for amebiasis. All patients were male of Polish nationality, 29-57 years old, who became ill after travel to Africa or India. Intestinal amebiasis was present only in two cases. Five patients had acute onset of disease and two chronic. The most common complaints included fever, abdominal pain, anorexia. A cough, chest pain, diarrhea or weight lose were less common. At physical examination paleness of skin, subjaundice, abdominal tenderness, hepatomegaly and sometimes pleural effusion have been observed. Laboratory tests revealed high RBS, leucocytosis and mild anemia. Slightly higher serum level of bilirubin, alkaline phosphatase were transient. Trophozoits of Entamoeba histolytica have been found in stool specimens of one only patient. Amebic antibodies tested with indirect hemagglutination (IHA) were present in all cases. Visual technics have shown abscess of 3 to 9 cm in diameter located at right liver lobe. Six patients have been treated with both chemotherapy (metronidazole or/and dehydroemetine) and "skin needle" aspiration. In two cases recrudescence of abscess has been observed after one and three years respectively. These two patients have been undergone second course of treatment with using not only needle aspiration and metronidazole/dehydroemetine but luminal agents as well.
Insights
This study observed seven male patients with amebic liver abscesses, diagnosed via imaging and serology. Treatment involved chemotherapy and aspiration, with two patients experiencing recurrence requiring additional luminal agents.
Area of Science:
- Infectious Diseases
- Hepatology
- Medical Diagnostics
Context:
- Observational study of amebic liver abscess (ALA) cases at Pomeranian Medical School (1989-1995).
- Focus on patients with ALA, often linked to travel history (Africa, India).
- Highlights diagnostic challenges, with intestinal amebiasis present in only two of seven cases.
Purpose:
- To report on the clinical presentation, diagnosis, and treatment outcomes of amebic liver abscess.
- To analyze the effectiveness of chemotherapy and aspiration in managing ALA.
- To document recurrence rates and the impact of additional luminal agents in ALA treatment.
Summary:
- Seven male patients diagnosed with ALA using epidemiological data, imaging (ultrasonography, CT, scintigraphy), and positive serologic tests (indirect hemagglutination).
- Common symptoms included fever, abdominal pain, and anorexia; physical findings revealed hepatomegaly and occasional pleural effusion.
- Diagnosis confirmed by imaging showing abscesses (3-9 cm) in the right liver lobe; Entamoeba histolytica trophozoites found in only one stool sample.
- Treatment comprised chemotherapy (metronidazole/dehydroemetine) and needle aspiration for six patients.
- Two patients experienced recurrence after 1 and 3 years, successfully treated with a second course including luminal agents.
Impact:
- Provides insights into the clinical spectrum and management of amebic liver abscess in a specific patient cohort.
- Emphasizes the importance of serological tests and imaging in ALA diagnosis, especially when intestinal symptoms are absent.
- Demonstrates the efficacy of combined chemotherapy and aspiration, while highlighting the need for luminal agents in managing recurrent cases.