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• Due to infection with the protozoan parasite Entamoeba histolytica
• Found in the stool of carriers in the cystic or trophozoite form
• Transmitted by the faecal-oral route
• The liver is the commonest extraintestinal site of infection
• 10% of affected patients develop liver abscesses
• Liver abscesses can be solitary or multiple
• 80% of abscess develop in right lobe of the liver
• Can present several years after intestinal infection

Clinical features

• Presents with malaise pyrexia and weight loss
• Right hypochondrial pain is often mild
• Less than 20% of patients present with diarrhoea
• Jaundice is uncommon
• Complications can arise as a result of abscess rupture or extension of infection
• Complications occur in 5% patients and include:
  • Amoebic empyema
  • Hepato-bronchial fistula
  • Lung abscess
  • Pericarditis
  • Peritonitis

Investigations

• Serology shows raised WCC and ESR
• Latex agglutination assay positive in more than 90%
• Sigmoidoscopy, stool microscopy and rectal biopsy may identify the organism
• Chest x-ray may show a raised right hemidiaphragm, atelectasis or abscess
• The abscess can often be identified on ultrasound
• Aspiration produces a typical 'anchovy sauce' appearing pus
• Pus is odourless and sterile on routine culture

Management

• Metronidazole is the antibiotic of choice
• If ineffective chloroquine and dihydrometine may be considered
• Ultrasound guided aspiration may be useful
• Surgery is only rarely required
• Prognosis in uncomplicated cases is good (<1%)
• If pulmonary complications occur mortality cab as high as 20%

Bibliography