Amebic Hepatic Abscesses Follow-up

  • Author: Daniel Matei Brailita, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 22, 2011
 

Further Outpatient Care

  • Follow-up ultrasonography or CT scan is unnecessary after resolution of symptoms and signs because the radiological resolution may take several months to years. See Prognosis.
  • Luminal amebicides fail to eradicate the luminal forms of E histolytica in approximately 10-15% of patients treated with these agents; therefore, a follow-up stool examination is recommended after completion of therapy. A second course of a luminal amebicide is required in a few weeks if the first course fails to eradicate the intestinal carriage.
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Deterrence/Prevention

  • Control of amebiasis can be achieved by exercising proper sanitary measures and avoiding fecally contaminated food and water.
    • Regular examination of food handlers and thorough investigation of diarrheal episodes may identify the source of infection in some communities.
    • Vegetables must be cleaned with a strong detergent soap and soaked in acetic acid or vinegar for approximately 15 minutes to eradicate the cyst forms.
    • Boiling is the only effective means of eradicating the cysts in water.
  • Change in sexual practices to avoid fecal-oral contamination is of importance in the male homosexual population.
  • Travelers to areas with suboptimal sanitation and hygiene should eat only cooked foods or fruits peeled by themselves and should avoid drinking local water, including ice cubes frequently used for cocktails.
  • Notably, many types of bottled water in developing countries are not properly disinfected.
  • No prophylactic vaccine currently is available for amebiasis, but efforts to better define antigenic candidates and wider use of animal models are encouraging.[28, 29]
    • A serine-rich E histolytica protein (SREHP) has been expressed in avirulent vaccine strains of Salmonella species.
    • E histolytica galactose/N -acetyl-D-galactosamine (Gal/GalNAc)[30] and synthetic enhanced intranasal lectin-based amebiasis subunits[31] have been extensively studied as attractive candidates for vaccine development.
    • Gal-inhibitable lectin shows promise in animal studies.[32]
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Complications

  • Pleuropulmonary infection is the most common complication. Mechanisms of infection include development of a sympathetic serous effusion; rupture of a liver abscess into the chest cavity, leading to empyema; or hematogenous spread, resulting in parenchymal infection.
  • Bronchopleural fistula may occur in rare instances when patients expectorate a substance that resembles anchovy paste. Trophozoites may be demonstrated in the fluid. Occasionally, this complication may be followed by a spontaneous cure of the amebic liver abscess.
  • Cardiac involvement results following the rupture of an abscess involving the left lobe of the liver. It usually is associated with very high mortality.
  • Intraperitoneal rupture occurs in 2-7% of patients. Left lobe abscesses are more likely to progress to rupture because of their later clinical presentation.
  • Bacterial superinfection can occur.
  • Rupture into peritoneal organs (eg, stomach) and mediastinum can occur.
  • Cases of hepatic artery pseudoaneurysm have been reported.
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Prognosis

  • In most cases, rapid clinical improvement is observed in less than 1 week with antiamebic drug therapy alone. Radiological resolution lags behind the resolution of clinical symptoms. The average time to radiological resolution is approximately 12 months, with a range of 3 months to more than 10 years.
  • Death occurs in approximately 5% of persons having extraintestinal infection, including liver abscess. Rupture into the peritoneal cavity and the pericardium are responsible for most deaths.
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Patient Education

  • Direct patient and public education at sanitary measures; personal hygiene, including hand washing; and food hygiene.
  • Educate travelers to endemic areas about the precautions needed. The details are discussed in Deterrence/Prevention.
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Contributor Information and Disclosures
Author

Daniel Matei Brailita, MD  Chief of Infectious Diseases, Mary Lanning Memorial Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

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

Disclosure: Nothing to disclose.

Ambrish Ojha, MD  Staff Physician, Department of Internal Medicine, Texas Tech University Health Sciences Center

Ambrish Ojha, MD is a member of the following medical societies: American College of Physicians and American 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.

Specialty Editor Board

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, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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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.
 
 
 
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