Amebic Liver Abscess

Alternative Names:Hepatic amebiasis; Extraintestinal amebiasis; Abscess – amebic liver
Definition :
Amebic liver abscess is a collection of pus in the liver caused by an intestinal parasite.Organisms that carry disease can travel through the blood stream into the liver and form an abscess, a collection of infected tissue and pus.

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Amebic liver abscess is an extraintestinal manifestation caused by a protozoa Entamoeba histolytica. The disease spreads through the ingestion of cysts in fecally-contaminated food or water. The infection is worldwide, most common in tropical areas usually in developing countries where poor sanitation exist.

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This is an Abscess (walled area of infection/pus) in the liver that is caused by the organism Entamoeba histolytica.  It is common in tropical and subtropical areas (southeast Asia, Africa, India, Latin America).  In the U.S., it is most common in young Hispanic adults.  It is also seen in those with recent travels to tropical areas, homosexuals, and among the inhabitants of institutions for the mentally ill.

Causes :-
Travel to endemic areas (as above), where the cysts of the parasite may be ingested by consuming water or food contaminated by fecal matter.
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 :-
*Malnutrition
*Old age
*Pregnancy
*Steroid use
*Cancer
*Immunosuppression
*Alcoholism
*Recent travel to a tropical region
*Homosexuality, particularly in males

Symptoms :-
There may or may not be symptoms of intestinal infection. Symptoms may include:
*Right upper abdominal pain
*Right sided chest pain worse on a deep breath
*Intense, continuous, or stabbing pain
*Chills
*Diarrhea precedes infection in 20% of patients
*Fever
*General discomfort, uneasiness, or ill feeling (malaise)
*Jaundice
*Joint pain
*Loss of appetite
*Sweating
*Weight loss
*malaise

Nature of the disease:-
Most infected people, perhaps 90%, are asymptomatic, but this disease has the potential to make the sufferer dangerously ill. It is estimated by the World Health Organization that about 70,000 people die annually worldwide.

Infections can sometimes last for years. Symptoms take from a few days to a few weeks to develop and manifest themselves, but usually it is about two to four weeks. Symptoms can range from mild diarrhoea to dysentery with blood and mucus. The blood comes from amoebae invading the lining of the intestine. In about 10% of invasive cases the amoebae enter the bloodstream and may travel to other organs in the body. Most commonly this means the liver, as this is where blood from the intestine reaches first, but they can end up almost anywhere.

Onset time is highly variable and the average asymptomatic infection persists for over a year. It is theorised that the absence of symptoms or their intensity may vary with such factors as strain of amoeba, immune response of the host, and perhaps associated bacteria and viruses.

In asymptomatic infections the amoeba lives by eating and digesting bacteria and food particles in the gut, a part of the gastrointestinal tract. It does not usually come in contact with the intestine itself due to the protective layer of mucus that lines the gut. Disease occurs when amoeba comes in contact with the cells lining the intestine. It then secretes the same substances it uses to digest bacteria, which include enzymes that destroy cell membranes and proteins. This process can lead to penetration and digestion of human tissues, resulting first in flask-shaped ulcers in the intestine. Entamoeba histolytica ingests the destroyed cells by phagocytosis and is often seen with red blood cells inside when viewed in stool samples. Especially in Latin America,  a granulomatous mass (known as an amoeboma) may form in the wall of the ascending colon or rectum due to long-lasting immunological cellular response, and is sometimes confused with cancer.

Theoretically, the ingestion of one viable cyst can cause an infection.

Diagnosis:
Exams and Tests
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

Treatment
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.

Prognosis:
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.
Possible Complications :In the majority of cases, amoebas remain in the gastrointestinal tract of the hosts. Severe ulceration of the gastrointestinal mucosal surfaces occurs in less than 16% of cases. In fewer cases, the parasite invades the soft tissues, most commonly the liver. Only rarely are masses formed (amoebomas) that lead to intestinal obstruction.

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.

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

Prevention:
To help prevent the spread of amoebiasis around the home :
*Wash hands thoroughly with soap and hot running water for at least 10 seconds after using the toilet or changing a baby’s diaper, and before handling food.
*Clean bathrooms and toilets often; pay particular attention to toilet seats and taps.
*Avoid sharing towels or face washers.

To help prevent infection:
*Avoid raw vegetables when in endemic areas, as they may have been fertilized using human feces.
*Boil water or treat with iodine tablets.
*When traveling in tropical countries where poor sanitation exists, drink purified water and do not eat uncooked vegetables or unpeeled fruit.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000211.htm
http://www.ecureme.com/emyhealth/data/Amebic_Liver_Abscess.asp
http://organizedwisdom.com/Amebic_Liver_Abscess
http://organizedwisdom.com/helpbar/index.html?return=http://organizedwisdom.com/Amebic_Liver_Abscess&url=en.wikipedia.org/wiki/Amoebiasis#Diagnosis_of_human_illness

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