Sociodemographic and Clinical Profile of Amoebic Liver Abscess observed at a Tertiary Referral Hospital over 10 Years

ABSTRACT

Aim: To study the sociodemographic factors, clinical features and treatment outcome of patients with amebic liver abscess. Methods: Prospective analysis of 163 consecutive patients with liver abscesses (mean age 39.5 years, 140 males). Amoebic aetiology was determined by various combinations of history of dysentery, radiological appearance, aspirated pus study, amebic serology, colonoscopy findingsand response to treatment. Sociodemographic factors associated with amoebic liver abscess included education, income, eating hygiene and alcohol consumption. All patients were treated with fine needle pus aspiration and intravenous metronidazole for at least 7 days. Results: 109(63.9%) abscesses were treated in the first 5 years. Antecedent diarrhoea was present in 27 (16.6%). 146 patients (89.6%) took nitroimidazoles frequently. Jaundice, mostly mild, occurred in 35%.E. histolytica was demonstrated in stool in 11 patients (6.7%) and in aspirated pus in 35 patients (21.5%). Serology was positive (>1160) in 53(32.5%) patients and was related to abscess size > 10 cm, presence of amoeba in pus and stool and positive colonoscopy findingsbut not to the number of abscesses. Colonoscopy revealed colitis in 21(12.9%) and caecal mass in 7(4.3%). All patients had prompt symptom relief with treatment without recurrence. 80% belonged to the lower middle class hailing from rural areas. 128(78.5%), all males, consumed 60 – 80 ml indigenously brewed liquor daily and they had poor personal and eating hygiene with higher antibody levels. 32 patients (19.6%) drank potable water. Conclusion: Though decreasing, amebic liver abscess continues to afflict heavy alcohol drinkers of lower socioeconomic strata, living in unhygienic conditions. Alcohol might influence seropositivity. Aspiration irrespective of size gives a lasting cure.