Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Amebiasis Amebic Liver Abscess 109

complications and prognosis

■Intestinal disease: perforation, hemorrhage, stricture. Prognosis

good with treatment.

■Systemic disease: rupture of liver abscess into peritoneum or pleuro-

pericardial spaces. This requires surgical drainage (possibly needle

drainage for pericardial rupture).

Amebic Liver Abscess.................................

AIJAZ AHMED, MD

history & physical

History

■Prevalence <1% in industrialized countries; 50–80% in tropical areas

■Fecal-oral spread by poor sanitation, contamination of food by flies,

unhygienic food handling, contaminated water, use of human feces

as fertilizer

■High-risk groups: lower socioeconomic status, immigrants, travel-

ers, male homosexuals & institutionalized populations

■Host factors predisposing to increased severity: age (children

>adults), pregnancy, malignancy, malnutrition/alcoholism, corti-

costeroid use

Signs & Symptoms

■Fever, rigors, night sweats, nausea, anorexia, malaise, right-sided

abdominal discomfort, weight loss, dry cough, pleuritic pain, shoul-

der pain, hiccups, tender hepatomegaly, dull right lung base (raised

hemidiaphragm), pleural rub, right basilar crackles

■Amebic colitis in 10%, past diarrhea/dysentery in 20%, & 50% w/

parasite in stool

tests

Laboratory

■Leukocytosis, anemia, – serum alkaline phosphatase, – AST/ALT,

• ESR
  ■Serologic tests:
  ■Indirect hemagglutination assay (IHA) 90–100% sensitive; combina-
  tion of immunofluorescent antibody test (IFAT) & cellulose acetate
  precipitin test (CAP) 100% sensitive; IHA positive for 2 y after therapy