Amoeba abscess L02.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Abscess tropical; amoebic liver abscess; tropical abscess

Definition
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Invasive extraintestinal form of an infection with amoebae. Metastatically formed abscess in amoebiasis. Mostly the right lobe of the liver is affected, more rarely the brain or lungs.

Pathogen
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Protozoa of the species Entamoeba histolytica, genus Entamoeba (Ruhr amoebae).

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Occurrence/Epidemiology
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  • Worldwide prevalence: about 50 million people worldwide contract invasive amoebiasis annually, up to 100,000 deaths annually (WHO, 1997).
  • Occurrence: mainly in warm countries with low hygienic standards, autochthonous infections in temperate zones very rare (e.g. sewage workers), occurrence in male homosexuals (oral-anal contact, rectal lavage).

Etiopathogenesis
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Faecal-oral uptake of cysts with contaminated food. Release of smaller, vegetative forms, so-called minuta forms (trophozoites) from cysts in the intestine. Trophozoites multiply by bifurcation and form cysts which are excreted with the stool in a mature, quadrenuclear state. When trophozoites penetrate the intestinal wall and phagocytise erythrocytes, they become so-called magnaforms.

Manifestation
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Amoebic liver abscess: mainly men are affected (m:w = 5:1).

Localization
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Mostly in the right lobe of the liver. May spread to the pleura, pericardium and brain.

Clinical features
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Acute, cramp-like pain in the upper abdomen (predominantly on the right side) radiating to the back, thorax or shoulder. Hepatomegaly often exists. Fever. The skin is usually not affected.

Diagnosis
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  • In the chair:
    • Stool microscopy (sensitivity of 70%): MIFC method in stool (preferably in native stool, fresh stool/mucus flake [in 3 stool samples]).
    • Antigen detection (ELISA, sensitivity comparable to microscopy)
    • PCR (highest sensitivity).
  • In serum (indication of invasion):
    • Serum antibodies (ELISAA
    • Transaminases, cholestasis parameters
    • Inflammation parameters
    • Blood count
    • Electrolytes.
  • In the pointat:
    • Microscopy
    • PCR.
  • Imaging (abscess):
    • Abdominal sonography
    • CT.

Differential diagnosis
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Diseases that can be associated with similar clinic:

Complication(s)
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Perforation. In case of haematogenous scattering: pleural empyema, pulmonary abscess, hepatobronchial fistula, pericardial abscess.

Therapy
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  • Standard: Metronidazole 3 times/day 10 mg/kg bw (max. 3 times/day 800 mg) i.v. or orally over 10 days (dosage for adults and children).
  • In mild cases: Tinidazole 2 g/day orally for 5 days (children: 30 mg/kg bw/day, maximum 2 g/day). Tinidazole is no longer approved in Germany, but is available from pharmacies abroad ( off-label use).
  • Subsequently cyst treatment: Paromomycin 3 times/day 500 mg/day p.o. for 9-10 days (children: 10 mg/kg bw/day).
  • Alternatively: Diloxanidfuroat, Nimorazol, Chloroquin.
  • In pregnant women: treatment indicated (however, 5-nitroimidazole should not be given in the 1st trimester).

Note(s)
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  • Symptomatic amebiasis: notifiable occupational disease (in the context of occupational exposure), No 3101 or 3104 of the list of occupational diseases.
  • Current therapy recommendations can be found in the AWMF guidelines.

Literature
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  1. AWMF Guideline for the diagnosis and treatment of amoebic dysentery and amoebic liver abscess. Status 02/2006
  2. Bercu TE et al (2007) Amebic colitis: new insights of pathogenesis and treatment. Curr Gastroenterol 9: 429-433
  3. Nagar AB (2007) Isolated colonic ulcers: diagnosis and management. Curr Gastroenterol Rep 9: 422-428
  4. Salles JM et al (2007) Invasive amoebiasis: an update of diagnosis and management. Expert Rev Anti Infect Ther 5: 893-901

Incoming links (2)

Abscess, tropical; Amebiasis;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020