Amoebic liver abscess overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
[[Amoebiasis]] was first described as a deadly disease by Hippocrates. <ref name="pmid14557296">{{cite journal| author=Tanyuksel M, Petri WA| title=Laboratory diagnosis of amebiasis. | journal=Clin Microbiol Rev | year= 2003 | volume= 16 | issue= 4 | pages= 713-29 | pmid=14557296 | doi= | pmc=207118 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14557296 }} </ref>. The first case of [[amoebiasis]] was documented in 1875. | [[Amoebiasis]] was first described as a deadly [[disease]] by [[Hippocrates]]. <ref name="pmid14557296">{{cite journal| author=Tanyuksel M, Petri WA| title=Laboratory diagnosis of amebiasis. | journal=Clin Microbiol Rev | year= 2003 | volume= 16 | issue= 4 | pages= 713-29 | pmid=14557296 | doi= | pmc=207118 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14557296 }} </ref>. The first case of [[amoebiasis]] was documented in 1875. | ||
==Classification== | ==Classification== | ||
Revision as of 18:21, 7 March 2017
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Amoebic liver abscess Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Synonyms and keywords: Hepatic amoebiasis; Extraintestinal amoebiasis; Abscess-amoebic liver
Overview
Amoebic liver abscess is caused by a protozoan Entamoeba histolytica. Is it an inflammatory space occupying lesion in liver.
Historical Perspective
Amoebiasis was first described as a deadly disease by Hippocrates. [1]. The first case of amoebiasis was documented in 1875.
Classification
Liver abscess may be classified into 3 types based on etiology into pyogenic, amoebic, and fungal liver abscess.[2]. Based on duration of symptoms, amoebic liver abscess is classified into acute and chronic.
Pathophysiology
Ameoebic liver abscess is caused by a protozoan Entamoeba histolytica. It is the most common extraintestinal manifestation of amoebiasis. The mode of transmission of Entamoeba histolytica include fecal-oral route (ingestion of food and water contaminated with feces containing cysts), sexual transmission via oral-rectal route in homosexuals, vector transmission via flies, cockroaches, and rodents.[3][4] Hepatocyte programmed cell death induced by Entamoeba histolytica causes amoebic liver abscess. The infection is transmitted to liver by portal venous system.[5]
Causes
Amoebic liver abscess is caused by a protozoan Entamoeba histolytica.
Differential Diagnosis
Epidemiology And Demographics
Amoebiasis is the second leading cause of death worldwide from parasitic disease.[6][7][8]500 million people are infected with Entamoeba histolytica every year. 50 million individuals develop liver abscess and colitis and results in death in 40,000-100,000 individuals annually. Of all cases of amoebiasis, 3% to 9% of patients reported to have amoebic liver abscess. It most commonly occurs in 20 to 45 years age.
Risk Factors
Common risk factors in the development of amoebic liver abscess include alcoholism, pregnancy, malnutrition, old age, immunosupression (including HIV), a recent travel to a tropical region, steroid use, hypoalbuminemia, chronic infection,tuberculosis, syphilis, splenectomy, malignancy, and homosexual.[9][10]
Screening
According to the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for Entamoeba histolytica infection.
Natural history, Complications And Prognosis
If left untreated, amoebic liver abscess may disseminate to other organs leading to death.[11]The complications of amoebic liver abscess develop due to rupture of the abscess into the abdomen or chest cavity. The complications include peritonitis, pericarditis / pneumopericardium / tamponade, pleuropulmonary / pneumothorax (the right lung and pleural space are frequently effected because of their proximity to the liver), obstructive jaundice, bacterial superinfection, cutaneous fistulization of chest and abdominal wall, inferior venacava obstruction, hemobilia / thoracobilia, internal fistulization, systemic inflammatory response syndrome, Venous and arterial thrombosis.[12][13][14][15][16][17][18][19][20][21][22][23]Prognosis is good with treatment. Patients who are treated have high chance of complete recovery or minor complications.[24]
Diagnosis
History And Symptoms
Specific areas of focus when obtaining a history from the patient include history of recent travel to or resident of endemic areas, time of onset (duration of symptoms <14 days), history of dysentery within the previous few months, fever and abdominal pain.[1]Symptoms of amoebic liver abscess include moderate to severe abdominal pain, malaise, loss of appetite, sweating, weight loss, epigastric pain (Commonly seen in left lobe abscesses), fever (high fever with chills is suggestive of secondary bacterial infection), anorexia, pleuritic chest pain, Cough with or without expectoration and chest pain (may be due to abscess rupture into the pleural cavity), jaundice, confusion, abdominal distension, nausea and vomiting, diarrhea and constipation[22][10][25][26][27][28]
Physical Examination
Common physical examination findings associated with amoebic liver abscess may include sweating and ill appearing patient with weight loss, fever with chills, tachycardia, yellowish discoloration of skin, icteric sclera, reduced breath sounds or crepitations at right lung base may be heard, chest tenderness on palpation and audible pericardial friction rub. Hepatomegaly with point tenderness over the liver, in the intercostal spaces, or below the ribs is a typical finding Epigastric mass if left lobe is involved. Abdominal guarding or rebound tenderness, dullness on percussion, abdominal distension and absent bowel sounds are other findings.[29][30][31]
Laboratory findings
Laboratory tests consistent with diagnosis of amoebic liver abscess include complete blood picture, ESR, C-reactive protein, liver function tests, and stool examination.[1][32][33][34]
ECG
There are no ECG findings associated with amoebic liver abscess.
Chest X Ray
Chest X ray findings include pleural effusion, elevated right hemidiaphtagm, atelectasis, and types of hepatic abscesses.[10][35]
CT Scan
CT scan findings of amoebic liver abscess include shape of abscess, varying sizes ranging from 4 cm to 12 cm, well defined lesion with attenuation values indicating the presence of complex fluid, wall enhancement, peripheral zone of edema with wall thickness around 3-15 mm, the central abscess cavity with septations and/or fluid-debris levels, and gas in the abscess if associated with hepatobronchial fistula or a hepatocolic fistula.[35][10]
MRI
MRI findings of amoebic liver abscess include T1 weighted images with homogenous low signal intensity (signal homogeneity within the abscess can be present more often on T1- than on T2-weighted images) and T2 images are generally homogeneous with high signal intensity and perilesional oedema may be seen in half of the cases.[35][10]
Ultrasonography
Ultrasound is the gold standard technique for the diagnosis of amoebic liver abscess. The intrahepatic ultrasound findings include homogenous hypoechoic areas that can be single or multiple with round edges, round or oval in shape and variable size (around 2-6 cm in diameter), an incomplete rim of edema, location near liver capsule, margin of abscess tends to be nodular in around 40% of cases and smooth in 60% of cases, internal septations may be present in 30% of cases, and focal intrahepatic biliary dilatation peripheral to an abscess may be present. The extra hepatic findings include pleural effusion, perihepatic fluid collection, gastric or colonic involvement and retroperitoneal extension.[35][36]
Other Imaging Studies
Other imaging studies include technitium-99m liver scanning, gallium citrate scan and hepatic angiography.[37][38][39]
Other Diagnostic Studies
Other diagnostic studies include microscopic techniques, culture methods, isoenzyme analysis, antibody detection tests, antigen detection tests, immunochromatographic assays and DNA based diagnostic tests.[40][1][9][41][41]
Treatment
Medical Therapy
Indications for medical management of amoebic liver abscess are all non-complicated abscesses, no compression effect, and no features of rupture or impending rupture. Treatment of intraluminal infection include iodoquinol, metronidazole, tinidazole, and paromomycin.[42]
Surgical Therapy
Surgery is not the mainstay of treatment. Percutaneous needle aspiration and surgical open drainage are the surgical methods used to treat amoebic liver abscess.[43][44]
Primary Prevention
Primary prevention of amoebic liver abscess include drinking purified water and eat well-cooked food while traveling in tropical countries with poor sanitation, boiling water before drinking, raw vegetables must be washed with soap and then soaked in vinegar for 15 min before they can be eaten, and screening of family members to prevent spread of disease:[45]
Secondary Prevention
The secondary prevention of amoebic liver abscess includes long-term follow-up after treatment. Ultrasound is the main imaging technique used during the follow-up period. The mean time for the disappearance of sonographic features (hypoechoic lesions) is 6-9 months.
References
- ↑ 1.0 1.1 1.2 1.3 Tanyuksel M, Petri WA (2003). "Laboratory diagnosis of amebiasis". Clin Microbiol Rev. 16 (4): 713–29. PMC 207118. PMID 14557296.
- ↑ Mavilia MG, Molina M, Wu GY (2016). "The Evolving Nature of Hepatic Abscess: A Review". J Clin Transl Hepatol. 4 (2): 158–68. doi:10.14218/JCTH.2016.00004. PMC 4913073. PMID 27350946.
- ↑ Fletcher SM, Stark D, Harkness J, Ellis J (2012). "Enteric protozoa in the developed world: a public health perspective". Clin Microbiol Rev. 25 (3): 420–49. doi:10.1128/CMR.05038-11. PMC 3416492. PMID 22763633.
- ↑ Stanley SL (2003). "Amoebiasis". Lancet. 361 (9362): 1025–34. doi:10.1016/S0140-6736(03)12830-9. PMID 12660071.
- ↑ Aikat BK, Bhusnurmath SR, Pal AK, Chhuttani PN, Datta DV (1979). "The pathology and pathogenesis of fatal hepatic amoebiasis--A study based on 79 autopsy cases". Trans. R. Soc. Trop. Med. Hyg. 73 (2): 188–92. PMID 473308.
- ↑ Leber, Amy L., and Susan Novak-Weekley. "Intestinal and urogenital amebae, flagellates, and ciliates." Manual of Clinical Microbiology, 10th Edition. American Society of Microbiology, 2011. 2149-2171.
- ↑ Baxt LA, Singh U (2008). "New insights into Entamoeba histolytica pathogenesis". Curr Opin Infect Dis. 21 (5): 489–94. doi:10.1097/QCO.0b013e32830ce75f. PMC 2688559. PMID 18725798.
- ↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
- ↑ 9.0 9.1 Krogstad DJ, Spencer HC, Healy GR, Gleason NN, Sexton DJ, Herron CA (1978). "Amebiasis: epidemiologic studies in the United States, 1971-1974". Ann Intern Med. 88 (1): 89–97. PMID 619763.
- ↑ 10.0 10.1 10.2 10.3 10.4 Ximénez C, Morán P, Rojas L, Valadez A, Gómez A, Ramiro M; et al. (2011). "Novelties on amoebiasis: a neglected tropical disease". J Glob Infect Dis. 3 (2): 166–74. doi:10.4103/0974-777X.81695. PMC 3125031. PMID 21731305.
- ↑ Kurt Ö, Aktaş N, Çalışkan C, Karatuna O, Aygün H, Akyar I (2015). "[Amoebic liver abscess in a patient initially diagnosed with pneumonia: case report and discussion of relevant literature]". Turkiye Parazitol Derg. 39 (1): 70–4. doi:10.5152/tpd.2015.3608. PMID 25917589.
- ↑ Meng XY, Wu JX (1994). "Perforated amebic liver abscess: clinical analysis of 110 cases". South Med J. 87 (10): 985–90. PMID 7939926.
- ↑ Peres LC, Saggioro FP, Dias LB, Alves VA, Brasil RA, Luiz VE; et al. (2008). "Infectious diseases in paediatric pathology: experience from a developing country". Pathology. 40 (2): 161–75. doi:10.1080/00313020701816357. PMID 18203038.
- ↑ Salles JM, Moraes LA, Salles MC (2003). "Hepatic amebiasis". Braz J Infect Dis. 7 (2): 96–110. PMID 12959680.
- ↑ Archampong EQ (1972). "Peritonitis from amoebic liver abscess". Br J Surg. 59 (3): 179–81. PMID 5014518.
- ↑ Sarda AK, Bal S, Sharma AK, Kapur MM (1989). "Intraperitoneal rupture of amoebic liver abscess". Br J Surg. 76 (2): 202–3. PMID 2702459.
- ↑ Ganesan TK, Kandaswamy S (1975). "Amebic pericarditis". Chest. 67 (1): 112–3. PMID 1235314.
- ↑ Ibarra-Pérez C (1981). "Thoracic complications of amebic abscess of the liver: report of 501 cases". Chest. 79 (6): 672–7. PMID 7226956.
- ↑ Shamsuzzaman SM, Hashiguchi Y (2002). "Thoracic amebiasis". Clin Chest Med. 23 (2): 479–92. PMID 12092041.
- ↑ Adeyemo AO, Aderounmu A (1984). "Intrathoracic complications of amoebic liver abscess". J R Soc Med. 77 (1): 17–21. PMC 1439560. PMID 6699845.
- ↑ Lyche KD, Jensen WA (1997). "Pleuropulmonary amebiasis". Semin Respir Infect. 12 (2): 106–12. PMID 9195675.
- ↑ 22.0 22.1 Lyche KD, Jensen WA, Kirsch CM, Yenokida GG, Maltz GS, Knauer CM (1990). "Pleuropulmonary manifestations of hepatic amebiasis". West J Med. 153 (3): 275–8. PMC 1002529. PMID 2219891.
- ↑ Takhtani D, Kalagara S, Trehan MS, Chawla Y, Suri S (1996). "Intrapericardial rupture of amebic liver abscess managed with percutaneous drainage of liver abscess alone". Am J Gastroenterol. 91 (7): 1460–2. PMID 8678020.
- ↑ Sharma MP, Dasarathy S, Verma N, Saksena S, Shukla DK (1996). "Prognostic markers in amebic liver abscess: a prospective study". Am J Gastroenterol. 91 (12): 2584–8. PMID 8946991.
- ↑ Ximénez C, Morán P, Rojas L, Valadez A, Gómez A (2009). "Reassessment of the epidemiology of amebiasis: state of the art". Infect Genet Evol. 9 (6): 1023–32. doi:10.1016/j.meegid.2009.06.008. PMID 19540361.
- ↑ Pritt BS, Clark CG (2008). "Amebiasis". Mayo Clin Proc. 83 (10): 1154–9, quiz 1159-60. doi:10.4065/83.10.1154. PMID 18828976.
- ↑ Ali IK, Solaymani-Mohammadi S, Akhter J, Roy S, Gorrini C, Calderaro A; et al. (2008). "Tissue invasion by Entamoeba histolytica: evidence of genetic selection and/or DNA reorganization events in organ tropism". PLoS Negl Trop Dis. 2 (4): e219. doi:10.1371/journal.pntd.0000219. PMC 2274956. PMID 18398490.
- ↑ Ximénez C, Cerritos R, Rojas L, Dolabella S, Morán P, Shibayama M; et al. (2010). "Human amebiasis: breaking the paradigm?". Int J Environ Res Public Health. 7 (3): 1105–20. doi:10.3390/ijerph7031105. PMC 2872301. PMID 20617021.
- ↑ https://medlineplus.gov/ency/article/000211.htm Accessed on february 8, 2017
- ↑ Hoffner RJ, Kilaghbian T, Esekogwu VI, Henderson SO (1999). "Common presentations of amebic liver abscess". Ann Emerg Med. 34 (3): 351–5. PMID 10459092.
- ↑ Wiwanitkit V (2002). "A note on clinical presentations of amebic liver abscess: an overview from 62 Thai patients". BMC Fam Pract. 3: 13. PMC 122079. PMID 12149132.
- ↑ Blessmann J, Binh HD, Hung DM, Tannich E, Burchard G (2003). "Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study". Trop Med Int Health. 8 (11): 1030–4. PMID 14629771.
- ↑ Nazir Z, Moazam F (1993). "Amebic liver abscess in children". Pediatr Infect Dis J. 12 (11): 929–32. PMID 8265284.
- ↑ Thompson JE, Glasser AJ (1986). "Amebic abscess of the liver. Diagnostic features". J Clin Gastroenterol. 8 (5): 550–4. PMID 3782753.
- ↑ 35.0 35.1 35.2 35.3 https://radiopaedia.org/articles/amoebic-hepatic-abscess Accessed on February 7, 2017
- ↑ Kimura K, Stoopen M, Reeder MM, Moncada R (1997). "Amebiasis: modern diagnostic imaging with pathological and clinical correlation". Semin Roentgenol. 32 (4): 250–75. PMID 9362096.
- ↑ Nelson MJ, Klopper JF (1985). "[Study of space-occupying lesions in the liver using technetium-99m tin colloid and indium-113m chloride]". S Afr Med J. 67 (4): 121–4. PMID 2982217.
- ↑ Farid Z, Trabolsi B, Kilpatrick ME, Yassin WM, Watten RH (1982). "Ameobic liver abscess presenting as fever of unknown origin (FUO). Serology, isotope scanning and metronidazole therapy in diagnosis and treatment". J Trop Med Hyg. 85 (6): 255–8. PMID 7154149.
- ↑ Lomas F, Dibos PE, Wagner HN (1972). "Increased specificity of liver scanning with the use of 67 gallium citrate". N Engl J Med. 286 (25): 1323–9. doi:10.1056/NEJM197206222862501. PMID 4337453.
- ↑ Huston CD, Haque R, Petri WA (1999). "Molecular-based diagnosis of Entamoeba histolytica infection". Expert Rev Mol Med. 1999: 1–11. doi:doi:10.1017/S1462399499000599 Check
|doi=value (help). PMID 14987356. - ↑ 41.0 41.1 Clark CG, Diamond LS (2002). "Methods for cultivation of luminal parasitic protists of clinical importance". Clin Microbiol Rev. 15 (3): 329–41. PMC 118080. PMID 12097242.
- ↑ Petri WA, Singh U (1999). "Diagnosis and management of amebiasis". Clin Infect Dis. 29 (5): 1117–25. doi:10.1086/313493. PMID 10524950.
- ↑ vanSonnenberg E, Mueller PR, Schiffman HR, Ferrucci JT, Casola G, Simeone JF; et al. (1985). "Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage". Radiology. 156 (3): 631–5. doi:10.1148/radiology.156.3.4023220. PMID 4023220.
- ↑ Aucott JN, Ravdin JI (1993). "Amebiasis and "nonpathogenic" intestinal protozoa". Infect Dis Clin North Am. 7 (3): 467–85. PMID 8254155.
- ↑ Wuerz T, Kane JB, Boggild AK, Krajden S, Keystone JS, Fuksa M; et al. (2012). "A review of amoebic liver abscess for clinicians in a nonendemic setting". Can J Gastroenterol. 26 (10): 729–33. PMC 3472914. PMID 23061067.