Medscape is available in 5 Language Editions – Choose your Edition here.


Amebic Hepatic Abscesses Differential Diagnoses

  • Author: Daniel Matei Brailita, MD; Chief Editor: BS Anand, MD  more...
Updated: Apr 15, 2015

Diagnostic Considerations

Important considerations

Persistence of cavity alone after therapy, without associated signs and symptoms, does not indicate the need for repeating antibiotic therapy. (See Prognosis.)

The cavitary lesions of amebic liver abscess and hepatocellular carcinoma can be confused, particularly in areas of the world where the frequency of both conditions is high.

The absence of a rapid response to medical therapy warrants further diagnostic evaluation to rule out pyogenic abscess or hepatoma.

Failure to use luminal agents after tissue amebicides can lead to relapse of infection in approximately 10% of patients.

Special concerns

Treat women who develop hepatic amebiasis during pregnancy with metronidazole, although some theoretical risks are involved. No adverse outcomes have been reported in a long-term follow-up study of pregnant women given metronidazole for trichomoniasis.

Other problems to be considered

When evaluating patients with suspected amebic hepatic abscesses, also consider the following conditions:

  • Hepatitis
  • Pneumonia
  • Pulmonary disease

Differential Diagnoses

Contributor Information and Disclosures

Daniel Matei Brailita, MD Infectious Disease Specialist, Mary Lanning Healthcare and Central Nebraska Infectious Diseases

Daniel Matei Brailita, MD is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, HIV Medicine Association

Disclosure: Nothing to disclose.


KoKo Aung, MD, MPH, FACP Chief, Division of General Internal Medicine, O Roger Hollan Professor of Internal Medicine, Director, Office of Educational Programs, Department of Medicine, University of Texas Health Science Center at San Antonio

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Ildiko Lingvay, MD, MPH, MSc Assistant Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Texas Southwestern Medical Center at Dallas

Ildiko Lingvay, MD, MPH, MSc is a member of the following medical societies: Endocrine Society, Texas Medical Association

Disclosure: Received consulting fee from GI Dynamics for consulting; Received honoraria from NovoNordisk, Inc for board membership.

Ambrish Ojha, MBBS 

Ambrish Ojha, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Robert J Fingerote, MD, MSc, FRCPC Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Ontario

Robert J Fingerote, MD, MSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Association

Disclosure: Nothing to disclose.


Harvey Kantor, MD Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Texas Tech University Health Science Center

Harvey Kantor, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Illinois State Medical Society, Infectious Diseases Society of America, New York Academy of Sciences, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

  1. Blazquez S, Rigothier MC, Huerre M, et al. Initiation of inflammation and cell death during liver abscess formation by Entamoeba histolytica depends on activity of the galactose/N-acetyl-D-galactosamine lectin. Int J Parasitol. 2007 Mar. 37(3-4):425-33. [Medline].

  2. Stanley SL Jr. Amoebiasis. Lancet. 2003 Mar 22. 361(9362):1025-34. [Medline].

  3. Acuna-Soto R, Maguire JH, Wirth DF. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol. 2000 May. 95(5):1277-83. [Medline].

  4. Blessmann J, Ali IK, Nu PA, et al. Longitudinal study of intestinal Entamoeba histolytica infections in asymptomatic adult carriers. J Clin Microbiol. 2003 Oct. 41(10):4745-50. [Medline].

  5. Haque R, Duggal P, Ali IM, et al. Innate and acquired resistance to amebiasis in bangladeshi children. J Infect Dis. 2002 Aug 15. 186(4):547-52. [Medline].

  6. Ralston KS, Petri WA Jr. Tissue destruction and invasion by Entamoeba histolytica. Trends Parasitol. 2011 Jun. 27(6):254-63. [Medline]. [Full Text].

  7. Hoffner RJ, Kilaghbian T, Esekogwu VI, et al. Common presentations of amebic liver abscess. Ann Emerg Med. 1999 Sep. 34(3):351-5. [Medline].

  8. Hughes MA, Petri WA Jr. Amebic liver abscess. Infect Dis Clin North Am. 2000 Sep. 14(3):565-82, viii. [Medline].

  9. Ravdin JI. Amebiasis. Clin Infect Dis. 1995 Jun. 20(6):1453-64; quiz 1465-6. [Medline].

  10. Ravdin JI, Stauffer W. Entamoeba histolytica (amebiasis). Mandell Gl, Bennett J, Dolin R eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2005. Vol 2: Part III, sect H, 3097-3111.

  11. Mbaye PS, Koffi N, Camara P, et al. [Pleuropulmonary manifestations of amebiasis]. Rev Pneumol Clin. 1998 Dec. 54(6):346-52. [Medline].

  12. Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev. 2003 Oct. 16(4):713-29. [Medline].

  13. Solaymani-Mohammadi S, Rezaian M, Babaei Z, et al. Comparison of a stool antigen detection kit and PCR for diagnosis of Entamoeba histolytica and Entamoeba dispar infections in asymptomatic cyst passers in Iran. J Clin Microbiol. 2006 Jun. 44(6):2258-61. [Medline].

  14. Hamzah Z, Petmitr S, Mungthin M, et al. Differential detection of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii by a single-round PCR assay. J Clin Microbiol. 2006 Sep. 44(9):3196-200. [Medline].

  15. Khairnar K, Parija SC. A novel nested multiplex polymerase chain reaction (PCR) assay for differential detection of Entamoeba histolytica, E. moshkovskii and E. dispar DNA in stool samples. BMC Microbiol. 2007 May 24. 7:47. [Medline].

  16. Roy S, Kabir M, Mondal D, et al. Real-time-PCR assay for diagnosis of Entamoeba histolytica infection. J Clin Microbiol. 2005 May. 43(5):2168-72. [Medline].

  17. Qvarnstrom Y, James C, Xayavong M, et al. Comparison of real-time PCR protocols for differential laboratory diagnosis of amebiasis. J Clin Microbiol. 2005 Nov. 43(11):5491-7. [Medline].

  18. Otto MP, Gerome P, Rapp C, et al. False-negative serologies in amebic liver abscess: report of two cases. J Travel Med. 2013 Mar-Apr. 20(2):131-3. [Medline].

  19. Knobloch J, Mannweiler E. Development and persistence of antibodies to Entamoeba histolytica in patients with amebic liver abscess. Analysis of 216 cases. Am J Trop Med Hyg. 1983 Jul. 32(4):727-32. [Medline].

  20. Restrepo MI, Restrepo Z, Elsa Villareal CL, et al. Diagnostic tests for amoebic liver abscess: comparison of enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE). Rev Soc Bras Med Trop. 1996 Jan-Feb. 29(1):27-32. [Medline].

  21. Leo M, Haque R, Kabir M, et al. Evaluation of Entamoeba histolytica antigen and antibody point-of-care tests for the rapid diagnosis of amebiasis. J Clin Microbiol. 2006 Dec. 44(12):4569-71. [Medline].

  22. Bammigatti C, Ramasubramanian N, Kadhiravan T, Das AK. Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial. Trop Doct. 2013 Jan. 43(1):19-22. [Medline].

  23. Khan U, Mirdha BR, Samantaray JC, et al. Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess. Indian J Gastroenterol. 2006 Mar-Apr. 25(2):55-7. [Medline].

  24. Singh P, Mirdha BR, Ahuja V, Singh S. Evaluation of small-subunit rRNA touchdown polymerase chain reaction for direct detection of Entamoeba histolytica in human pus samples from patients with amoebic liver abscess. Indian J Med Microbiol. 2011 Apr-Jun. 29(2):141-6. [Medline].

  25. Khan R, Hamid S, Abid S, et al. Predictive factors for early aspiration in liver abscess. World J Gastroenterol. 2008 Apr 7. 14(13):2089-93. [Medline].

  26. Khanna S, Chaudhary D, Kumar A, et al. Experience with aspiration in cases of amebic liver abscess in an endemic area. Eur J Clin Microbiol Infect Dis. 2005 Jun. 24(6):428-30. [Medline].

  27. Blessmann J, Binh HD, Hung DM, et al. 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. 2003 Nov. 8(11):1030-4. [Medline].

  28. Maltz G, Knauer CM. Amebic liver abscess: a 15-year experience. Am J Gastroenterol. 1991 Jun. 86(6):704-10. [Medline].

  29. Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. 1998 Apr. 170(4):1035-9. [Medline].

  30. Stanley SL Jr. Vaccines for amoebiasis: barriers and opportunities. Parasitology. 2006. 133 Suppl:S81-6. [Medline].

  31. Snow MJ, Stanley SL Jr. Recent progress in vaccines for amebiasis. Arch Med Res. 2006 Feb. 37(2):280-7. [Medline].

  32. Houpt E, Barroso L, Lockhart L, et al. Prevention of intestinal amebiasis by vaccination with the Entamoeba histolytica Gal/GalNac lectin. Vaccine. 2004 Jan 26. 22(5-6):611-7. [Medline].

  33. Abd Alla MD, White GL, Rogers TB, et al. Adherence-inhibitory intestinal immunoglobulin a antibody response in baboons elicited by use of a synthetic intranasal lectin-based amebiasis subunit vaccine. Infect Immun. 2007 Aug. 75(8):3812-22. [Medline].

  34. Ivory CP, Chadee K. Intranasal immunization with Gal-inhibitable lectin plus an adjuvant of CpG oligodeoxynucleotides protects against Entamoeba histolytica challenge. Infect Immun. 2007 Oct. 75(10):4917-22. [Medline].

  35. Stanley SL Jr, Jackson TF, Foster L, et al. Longitudinal study of the antibody response to recombinant Entamoeba histolytica antigens in patients with amebic liver abscess. Am J Trop Med Hyg. 1998 Apr. 58(4):414-6. [Medline].

CT scan of the abdomen with IV and oral contrast is shown. Note the thick-walled cavity with low attenuation center and contrast-enhanced periphery.
CT scan of the abdomen with contrast showing large amebic abscess with multiloculated appearance and atypical left liver lobe location. CT scan cannot differentiate amebic liver abscess from pyogenic liver abscess.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.