Demographic, Clinical, Laboratory and Management Profile in Patients of Amoebic Liver Abscess from Northern India

Background: Amoebic liver abscess (ALA) is a serious extra-intestinal manifestation of amoebiasis and a major problem in developing countries. Due to rapid urbanization, improved sanitation and hygiene in India, there has been a shift in disease epidemiology towards non-communicable disease, but recent changes in epidemiological and clinical pattern in ALA are not well studied. Aim: To evaluate recent demographic, clinical, laboratory and management profile in patient with ALA. Methods: It is a prospective observational study conducted in the Department of Gastroenterology, SMS medical college, Jaipur, Rajasthan from June 2018 to December 2020. A predesigned semi structured questionnaire consisting of socio-demographic factors, risk factors, clinical, laboratory and management profile was used to collect data. Result: A total 508 patients of amoebic liver abscess were analysed. Median age of presentation was 40 years, majority were males (90.4%) with chronic alcoholism (44.1%) and belonging to lower socio-economic class. Abdominal pain, fever and anorexia were the most common symptoms. A majority had right lobe involvement (77.6%) and solitary abscess in 67.5%. Most of the small liver abscesses (68%) were managed by medical treatment alone. Percutaneous needle aspiration was done in 62.6% patients, mostly for abscess size 5-10 cm (93%) with 90% success. A total of 24.6% patients underwent percutaneous catheter drainage, all successfully done. Intraperitoneal rupture was seen in 10% patient. Mortality was 1.5%. Conclusion: This is one of the largest cohorts of ALA which shows that a majority of cases are males from lower socioeconomic status with history of significant alcohol intake. Early initiation of a combined therapeutic approach leads to early symptomatic improvement, fewer complications and better outcomes.

Management of complex hepatic abscess by percutaneous catheter drainage: a case report

Liver abscesses are a commonly encountered pathology in the tropical setting. Most commonly these are secondary to amoebic infestation. Majority of liver abscesses present with abdominal pain confined to the right hypochondrium. Smaller abscesses are easily dealt with by needle aspiration or catheter drainage under image guidance. Larger and complex abscesses are commonly dealt with by surgical drainage. We deal here with a case of complex liver abscesses which even had perforated into the pleural cavity. Keeping a close watch on the patient’s general condition which was satisfactory, we did not rush into a major surgical procedure. Wide antibiotic coverage and pulmonary care were initiated. Two pig-tail catheters were placed in separate abscesses and metronidazole irrigation periodically done. The daily drain output gradually reduced and we could successfully remove the two catheters at an interval. The patient made a good recovery and continues to do well on follow-up. We see in this case that even large and multiple abscesses if meticulously managed, surgical drainage can be avoided and catheter drainage provides satisfactory results. Good antibiotic coverage must continue in the follow-up period too.

Effect of lactobacillus postbiotics on entamoeba histolytica trophozoites

ABSTRACT Background Amebiasis is an infectious disease caused by Entamoeba histolytica. It represents one of the three worldwide leading causes of death by parasites and a public health problem due to its frequency, morbidity, mortality, and easy dispersion. Objective The study was aimed to evaluate the in vitro effect of Lactobacillus spp. postbiotics on E. histolytica trophozoites (HM1-IMSS strain) and to determine morphometric changes in trophozoite membrane by atomic force microscopy (AFM). Methods Bioassays on trophozoites were conducted with lyophilized postbiotics at 0.1, 0.3, and 0.5 mg/mL concentrations, and trophozoite samples were obtained for AFM analysis Results Results indicated postbiotic inhibitory activity; the highest percentage inhibition was 89.63% at 0.5 mg/mL. Trophozoites nanomechanical analysis showed 28.32% increase in ruggedness and 56% decrease in size with treatments compared to the control. Conclusion Our study showed that the synergy of Lactobacillus postbiotics inhibited E. histolytica HM1-IMSS in vitro growth under axenic conditions, inducing morphometric alterations in trophozoites’ cell membrane. These results would allow designing strategies or treatments aimed at E. histolytica control in the future.

Pleural amoebic empyema: a case report / 中国血吸虫病防治杂志

In this paper, a case of pleural amoebic empyema and its diagnosis and treatment were reported.

Pleural amoebic empyema: a case report / 中国血吸虫病防治杂志

In this paper, a case of pleural amoebic empyema and its diagnosis and treatment were reported.

Amoebic colitis with liver abscess

moebiasis is a parasitic infection caused by the intestinal protozoan Entamoeba histolytica, most prevalent in developing countries. It results in 40,000 to 100,000 deaths each year from amoebic colitis and extra intestinal infections. Amoebic liver abscess (ALA) is the most common extra intestinal site of infection with an incidence of between 3% and 9% of all cases of amoebiasis. Ultrasound which has a sensitivity of more than 90% for detecting ALA is highly recommended as an initial investigation followed by serological demonstration of circulating antibodies specific to Entamoeba histolytica.

Frequency of amoebiasis and other intestinal parasitoses in a settlement in Ilheus City, State of Bahia, Brazil

Introduction: This study evaluated the frequency of intestinal parasites, emphasizing the identification and differentiation of Entamoeba spp. Methods: Multiplex polymerase chain reaction (PCR), coproantigen tests and morphometric analysis were performed for Entamoeba spp. differentiation. Results: The overall frequency of intestinal parasites was 65%. Entamoeba histolytica was detected by the coproantigen test, and the PCR showed that Entamoeba dispar predominated in the population. In contrast, morphometric analysis was important for identifying Entamoeba hartmanni. Conclusions: It is possible to identify the causative agent of amoebiasis and to differentiate this agent from other species by combining techniques. .

Absceso hepático amebiano: Presentación de caso / Amebic liver abscess: Case report

El absceso hepático amebiano (AHA) es la manifestación extraintestinal más frecuente de la amebiasis. El AHA es resultado de la invasión de Entamoeba histolytica al hígado. Es una infección que está asociada a las malas condiciones de saneamiento ambiental y a los deficientes hábitos higiénicos. Es una patología que aún sigue presentado una alta morbilidad. En este artículo se informa un caso clínico y seguimiento de un paciente de 23 años con AHA, quien presenta la sintomatología típica a quien se suministra tratamiento etiológico adecuado. Adicionalmente, se realiza una revisión sobre el tema abordando los aspectos epidemiológicos más relevantes.

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. The AlA is a result of the invasion of Entamoeba histolytica in the liver. It is an infection that is associated with poor environmental sanitation and poor hygiene. It is a disease that is still presented a high morbidity. This article presents a case report and track a patient aged 23 with ALA, who has the typical symptoms who provided adequate etiological treatment is reported. Additionally, a review of the subject is done by addressing the most relevant epidemiological aspects.

Parasitic Diseases as the Cause of Death of Prisoners of War during the Korean War (1950-1953)

To determine the cause of death of prisoners of war during the Korean War (1950-1953), death certificates or medical records were analyzed. Out of 7,614 deaths, 5,013 (65.8%) were due to infectious diseases. Although dysentery and tuberculosis were the most common infectious diseases, parasitic diseases had caused 14 deaths: paragonimiasis in 5, malaria in 3, amoebiasis in 2, intestinal parasitosis in 2, ascariasis in 1, and schistosomiasis in 1. These results showed that paragonimiasis, malaria, and amoebiasis were the most fatal parasitic diseases during the early 1950s in the Korean Peninsula. Since schistosomiasis is not endemic to Korea, it is likely that the infected private soldier moved from China or Japan to Korea.

Clinical profile of amoebic colitis and its association with malabsorption.

Background: The amoebiasis is a very common problem of tropical countries like India. The association of malabsorption with amoebic colitis was studied in the present study from 1978 to 1980 in the tertiary care centre of Western Uttar Pradesh (India). Aims & Objective: The study was done with the aim of studying the clinical profile of chronic amoebic colitis and the incidence of malabsorption for fats, carbohydrates and proteins in cases of chronic amoebic infection of the intestine. Material and Methods: The study was carried out in 102 cases of chronic amoebic colitis and 25 age and sex matched controls. For the evidence of malabsorption, faecal fat excretion, D – Xylose excretion, total seum protein and albumin were estimated in all the cases. The patients who showed malabsorption were subjected to jejuna biopsy to know the histopathological findings. Results: Majority of cases (74%) were in the age groups of 21 – 40 years with decreasing incidence on either side. Pain in abdomen (98%) whether localised or diffuse was the commonest symptom followed by altered bowel habits (84%). Othe common symptoms were tenesmus (44%), increased gastro colic reflex (41%) and gaseous dyspepsia (19%). Among the physical signs palpable sigmoid colon was the commonest. Faecal fat excretion was less than 6gm/24 hours in majority (94.12%) of cases and malabsorption was found only in 5.88% of cases. D – Xylose excretion was more than 5 gm in majority (97.06%) and excretion less than 5 gm (malabsorption) was found in only 2.94% cases. Total serum proteins and albumin were between 6.1 to 7 gm and 3.1 to 4 gm respectively in majority (76.4% and 74.5%). Conclusion: Pain in abdomen was the most common symptom in amoebiasis. Amoebiasis does not cause significant malabsorption. Protein absorption was not affected much in amoebiasis.

Role of histopathological examination in nontraumatic perforation of colon.

Aim: Nontraumatic perforation of colon is an uncommon cause of peritonitis requiring early surgical intervention. This study was carried out to determine the prevalence patterns of the different etiologies of nontraumatic perforation of colon. Methods and results: A total of 35 patients with segments of colon or perforation margins removed for perforation were included. Most of the perforations occurred in the caecum, of which two were seen at the ileocaecal junction. The commonest cause was infection (amoebiasis :13 cases and tuberculosis : 5 cases) followed by ulcers of non specific ulcers (12 cases). There were three cases of adenocarcinoma causing secondary perforation and one case of idiopathic intestinal gangrene and volvulus each. Conclusion: In tropics, non traumatic perforations of colon most often involves caecal and ileocaecal segment and the most common etiology is amoebiasis.

An Unusual Case of Amoebic Liver Abscess Presenting with Hepatic Encephalopathy: A Case Report

Amoebic liver abscess (ALA) with jaundice and encephalopathy is a rare occurrence and has been recognised and studied more frequently in recent years. We present a case of massive ALA presenting with jaundice, hepatic encephalopathy, and septicaemia that was treated successfully with percutaneous drainage of the abscess, right-sided chest tube insertion, and anti-amoebic therapy.

Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature / 대한간학회지

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.

Secnidazole for metronidazole-resistant amebiasis

It is presented the case of a patient with intestinal colonization by Entamoeba histolytica, Entamoeba coli e Iodamoeba butschilli. Two treatments with metronidazole did not eradicate the protozoans, however, a treatment with secnidazole showed to be effective.

Apresenta-se uma mulher com colonização intestinal por Entamoeba histolytica, Entamoeba coli e lodamoeba butschilli. Dois tratamentos com metronidazol oral não erradicaram os protozoários, porém, um tratamento com secnidazol mostrou-se eficaz.

Participación del óxido nítrico durante el desarrollo del absceso hepático amebiano / Nitric oxide participation during amoebic liver abscess development

El óxido nítrico participa en funciones fisiológicas y fisiopatológicas, así como en el mecanismo de defensa del sistema inmunológico de mamíferos contra parásitos, virus y bacterias. La Entamoeba histolytica es un parásito protozoario causante de la amebiasis, la cual se caracteriza por el daño intestinal y la formación del absceso hepático amebiano (AHA). El desarrollo del absceso hepático amebiano en el hámster es similar al que desarrolla el humano, mientras que el ratón es resistente a la formación de este absceso, debido a un incremento en la producción de óxido nítrico. A diferencia del ratón, el desarrollo del absceso hepático amebiano en el hámster es debido a un exceso en la producción de óxido nítrico o posiblemente a una mayor susceptibilidad del hámster al daño producido por el óxido nítrico. Por lo tanto, sería importante realizar más estudios para determinar si en el humano, un exceso en la producción de óxido nítrico favorece la formación del absceso hepático amebiano.

Nitric oxide participates in both physiological and pathophysiological functions, and it plays an important role in the mammalian immune system in killing or inhibiting the growth of many pathogens, including parasites, viruses and bacteria. Entamoeba histolytica is a protozoan parasite that causes amoebiasis, which is characterized by intestinal damage and amoebic liver abscess development. The development of amoebic liver abscess in hamsters is similar to that in humans, whereas mice are resistant to amoebic liver abscess development due to an increase in nitric oxide production. Unlike in mice, amoebic liver abscess development in hamsters is due to an excess in nitric oxide production or possibly to a greater susceptibility of the hamster to damage caused by nitric oxide. Therefore, it could be important to elucidate if, in humans, an excess in nitric oxide production favors amoebic liver abscess development.

A Case of Multiple Opportunistic Gastrointestinal Infections in a Korean AIDS Patient / 대한소화기내시경학회지

The number of AIDS patients is currently increasing in Korea, and multiple opportunistic infections, which are due to their immunocompromised state, have become a significant clinical problem. These opportunistic diseases may vary according to the severity of immunosuppression, the mode of transmission, the risk factors, the living environment and treatment; rectal syphilis, perianal condyloma lata and amoebic liver abscess are known to rarely develop in AIDS patients. We report here on a case of a homosexual man who simultaneously presented with an amebic liver abscess, esophageal candidiasis, chronic hepatitis B, rectal syphilis, perianal condyloma lata and asymptomatic neurosyphilis. He was treated with highly active antiretroviral therapy (HARRT) and the appropriate antiviral and antibiotic agents.

Generalized Peritonitis due to Acute Fulminant Amoebic Colitis

An acute fulminant amoebic colits rarely develops as a complication of amoebiasis, and is difficult to diagnose and treat when it occurs. It is a life-threatening disease, and associated with a very high mortality rate. Herein, a case 42-old-year man, who had a generalized peritonitis caused by an acute fulminant amoebic colitis, is reported, with a review of the literature. He died of multiple organ failure, following sepsis and disseminated intravascular coagulation, on the 19th day after his operation, despite treatment with aggressive surgery and anti-amoebic agents. An emergency laparotomy should be considered when an acute fulminant amoebic colitis deteriorates despite the use of intensive anti-amoebic therapy, especially when there is an acute episode suggestive of perforation. A primary total resection of the diseased colon is one of the treatments of choice.

Amebiasis in children in the City of Manila with a report of 41 cases

1. An alarm has been sounded regarding the greatly increased incidence of amebic dysentery in children of Manila during the last year2. This report presents 41 such cases3. Symptoms presented by cases studied are familiar and more or less typical of textbook descriptions4. No definite conclusions can be made regarding therapy instituted. (Summary)

Pathogenesis of infection by Entamoeba histolytica.

Entamoeba histolytica, a protozoan parasite, is the etiologic agent of amoebiasis in humans. It exists in two forms—the trophozoite which is the active, dividing form, and the cyst which is dormant and can survive for prolonged periods outside the host. In most infected individuals the trophozoites exist as commensals. In a small percentage of infections, the trophozoites become invasive and penetrate the intestinal mucosa, causing ulcers. The trophozoites may reach other parts of the body—mainly liver, where they cause tissue necrosis, leading to life-threatening abscesses. It is thought that pathogenesis of infection by Entamoeba histolytica is governed at several levels, chief among them are (i) adherence of trophozoite to the target cell, (ii) lysis of target cell, and (iii) phagocytosis of target cell. Several molecules which may be involved in these processes have been identified. A lectin inhibitable by galactose and N-acetyl-D-galactosamine is present on the trophozoite surface. This is implicated in adherence of trophozoite to the target cell. Various amoebic pore-forming proteins are known, of which 5kDa protein (amoebapore) has been extensively studied. These can insert into the lipid bilayers of target cells, forming ion-channels. The phagocytic potential of trophozoites is directly linked to virulence as measured in animal models. Factors like association of bacteria with trophozoites also influence virulence. Thus, pathogenesis is determined by multiple factors and a unifying picture taking into account the relative contributions of each factor is sought. Recent technical advances, which includes the development of a transfection system to introduce genes into trophozoites, should help to understand the mechanism of pathogenesis in amoebiasis.

A Study on Children with Dysentery-like Stool from Taegu Area in 1980

A clinical and laboratory study was conducted on 75 children with dysentery-like stool, who had been admitted or visited to our pediatric department, during 8 months period from January to August 1980. The following results were obtained: One to five years of age group was affected most frequently(47%), Shigella flexneri was identified by stool culture in 23 cases(30%) and Entameba histolytica in 13 cases(17%). In bacillary dysentery group, fever was the most common symptom occuring in 83%, followed by abdominal pain in 35%. vomiting in 26% and convulsion in 22%. In amoebic dysentery group, fever was noted in 31% and convulsion in 8%, showing some contrast to the frequency of fever & CNS manifestation. About the character of diarrheal stool, 83% of bacillary dysentery group showed bloody, mucoid stool and 62% of amoebic dysentery group mucoid ones. Frequency of diarrhea was 11 times per day or more in 73% of bacillary dysentery patients, and 10 times per day or lese in 92% of amoebic dysentery patients. The result of sensitivity test of isolated Shigella to various antibiotics were as follow : 100% sensitive to kanamycin, gentamicin, amikacin, cephaloridine & rifampin, 87% to nalidixic acid, an4 4.3% to sulfonamide, chloramphcnicol, streptomycin, tetracyclin, ampicillin & bactrim. And 22 out of 23 isolated Shigella strains revealed multiple- drug-resistance pattern on 6 or more antibiotics.