Amoebic Liver Abscess management

Amoebic liver abscess is the most common extra-intestinal manifestation of Entamoeba histolytica infection. It occurs when the organism invades the portal venous system from the colon, causing hepatic inflammation and abscess formation, most commonly in the right lobe of the liver.

Clinical presentation

• High-grade fever (approximately 39°C)

• Right upper quadrant abdominal pain

• Tender hepatomegaly (tender enlarged liver)

Investigations

• Imaging evidence of liver abscess

• Serological evidence of Entamoeba histolytica antibodies or antigens

Pharmacological treatment

Metronidazole

• Dose: 800 mg

• Route: Intravenous (IV)

• Frequency: Every 8 hours

• Duration: 10 days

OR

Tinidazole

• Dose: 2 g

• Route: Oral (PO)

• Frequency: Once daily

• Duration: 3 days

Precautions

• Metronidazole and tinidazole should not be administered during the first trimester of pregnancy because of potential teratogenic effects.

• Alcohol should be avoided during treatment due to the risk of a disulfiram-like reaction.

Surgical Management

• Abscess cavities larger than 5 cm in diameter that fail to regress after 7 days of treatment should undergo aspiration.