eMedicine Specialties > Gastroenterology > Liver

Amebic Hepatic Abscesses: Follow-up

Author: Daniel Matei Brailita, MD, Chief of Infectious Diseases, Mary Lanning Memorial Hospital
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; KoKo Aung, MD, MPH, FACP, Associate Professor, Department of Medicine, University of Texas Health Science Center; Adjunct Assistant Professor of Public Health, University of Texas School of Public Health; Ambrish Ojha, MD, Staff Physician, Department of Internal Medicine, Texas Tech University Health Sciences Center; Harvey Kantor, MD, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Texas Tech University Health Science Center
Contributor Information and Disclosures

Updated: Sep 19, 2008

Follow-up

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.

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.26,27
    • 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)28 and synthetic enhanced intranasal lectin-based amebiasis subunits29 have been extensively studied as attractive candidates for vaccine development.
    • Gal-inhibitable lectin shows promise in animal studies.30

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • 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.
  • Absence of 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.
 


More on Amebic Hepatic Abscesses

Overview: Amebic Hepatic Abscesses
Differential Diagnoses & Workup: Amebic Hepatic Abscesses
Treatment & Medication: Amebic Hepatic Abscesses
Follow-up: Amebic Hepatic Abscesses
Multimedia: Amebic Hepatic Abscesses
References
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References

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Further Reading

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Keywords

amebic hepatic abscesses, amebic hepatic abscess, amebic liver abscesses, amebic liver abscess, hepatic amebiasis, amebic colitis, Entamoeba histolytica, E histolytica

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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; Adjunct Assistant 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.

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Alex J Mechaber, MD, FACP, 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; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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