Amoeba abscessL02.9
Synonym(s)
Abscess tropical; amoebic liver abscess; tropical abscess
DefinitionThis section has been translated automatically.
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.
PathogenThis section has been translated automatically.
Protozoa of the species Entamoeba histolytica, genus Entamoeba (Ruhr amoebae).
Occurrence/EpidemiologyThis section has been translated automatically.
- 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).
EtiopathogenesisThis section has been translated automatically.
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.
ManifestationThis section has been translated automatically.
Amoebic liver abscess: mainly men are affected (m:w = 5:1).
LocalizationThis section has been translated automatically.
Mostly in the right lobe of the liver. May spread to the pleura, pericardium and brain.
Clinical featuresThis section has been translated automatically.
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.
DiagnosisThis section has been translated automatically.
- 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 diagnosisThis section has been translated automatically.
Diseases that can be associated with similar clinic:
- Bacterial abscess
- Pyomyositis
- Melioidosis
- biliary ascaridiasis
- Fascioliasis
- Malignant tumor.
Complication(s)This section has been translated automatically.
Perforation. In case of haematogenous scattering: pleural empyema, pulmonary abscess, hepatobronchial fistula, pericardial abscess.
TherapyThis section has been translated automatically.
- 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)This section has been translated automatically.
- 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.
LiteratureThis section has been translated automatically.
- AWMF Guideline for the diagnosis and treatment of amoebic dysentery and amoebic liver abscess. Status 02/2006
- Bercu TE et al (2007) Amebic colitis: new insights of pathogenesis and treatment. Curr Gastroenterol 9: 429-433
- Nagar AB (2007) Isolated colonic ulcers: diagnosis and management. Curr Gastroenterol Rep 9: 422-428
- Salles JM et al (2007) Invasive amoebiasis: an update of diagnosis and management. Expert Rev Anti Infect Ther 5: 893-901