Hepatic amebiasis; Extraintestinal amebiasis; Abscess - amebic liver

Amebic liver abscess is caused by Entamoeba histolytica, the same organism that causes amebiasis, an intestinal infection. The organism is carried by the blood from the intestines to the liver.

The disease spreads through ingestion of cysts in fecally-contaminated food or water, use of human waste as fertilizer, and person-to-person contact.

The infection occurs worldwide, but is most common in tropical areas where crowded living conditions and poor sanitation exist. Africa, Latin America, Southeast Asia, and India have significant health problems associated with this disease.

Risk factors for amebic liver abscess include:

• Malnutrition
• Old age
• Pregnancy
• Steroid use
• Cancer
• Immunosuppression
• Alcoholism
• Recent travel to a tropical region
• Homosexuality, particularly in males

There may or may not be symptoms of intestinal infection. Symptoms may include:

• Abdominal pain
  • Particularly in the right, upper part of the abdomen
  • Intense, continuous, or stabbing pain
• Chills
• Diarrhea
• Fever
• General discomfort, uneasiness, or ill feeling (malaise)
• Jaundice
• Joint pain
• Loss of appetite
• Sweating
• Weight loss

Tests that may be done include:

• Abdominal ultrasound
• Abdominal CT scan or MRI
• Complete blood count
• Liver biopsy - rarely done due to high risk of complications
• Liver scan
• Liver function tests
• Serology for amebiasis

A medicine called metronidazole (Flagyl) is the usual treatment for liver abscess. Medications such as paromomycin must also be taken to remove intestinal amebiasis to prevent recurrence of the disease.

In rare cases, the abscess may need to be drained to help relieve some of the abdominal pain.

Without treatment, the abscess may rupture and spread into other organs, leading to death. Persons who receive treatment have a very high chance of a complete cure or having only minor complications.

The abscess may rupture into the abdominal cavity, the lining of the lungs, the lungs, or the sac around the heart. The infection can also spread to the brain.

Call your health care provider if symptoms develop after travel to an area where the disease is known to occur.

When traveling in tropical countries where poor sanitation exists, drink purified water and do not eat uncooked vegetables or unpeeled fruit.

Wells CD, Arguedas M. Amebic liver abscess. South Med J. 2004 Jul;97(7):673-82.

Torre A, Kershenobich D. Amebic liver abscess. Ann Hepa tol. 2002 Jan-Mar;1(1):45-7.

Feldman M, Friedman LS, Sleisenger MH, eds. Amebic Liver Abscess. In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th Ed. Philadelphia, PA: Saunders; 2002:1345-1346.