Abscess liver

E. histolytica and G. lamblia are waterborne infectious diseases that cause colitis and liver abscess, and enteritis, respectively. 

Liver As above but add a first-generation cephalosporin Use metronidazole if amoebic liver abscess is suspected... 

Acute intraabdominal contamination, such as after a traumatic injury, may be treated with a very short course (24 hours) of antimicrobials.25 For established infections (i.e., peritonitis or intraabdominal abscess), an antimicrobial course limited to 5 to 7 days is justified. Under certain conditions, therapy for longer than 7 days would be justified, e.g., if the patient remains febrile or is in poor general condition, when relatively resistant bacteria are isolated, or when a focus of infection in the abdomen still may be present. For some abscesses, such as pyogenic liver abscess, antimicrobials may be required for a month or longer. 

E. histolytica invades mucosal cells of colonic epithelium, producing the classic flask-shaped ulcer in the submucosa. The trophozoite toxin has a cytocidal effect on cells. If the trophozoite gets into the portal circulation, it will be carried to the liver, where it produces abscess and periportal fibrosis. Liver abscesses are more common in men than women and are rarely seen in children. Amebic ulcerations can affect the perineum and genitalia, and abscesses may occur in the lung and brain. 

Erosion of liver abscesses can result in peritonitis. Liver abscesses that are located in the right lobe can spread to the lungs and pleura. Pericardial infection, although rare, may be associated with extension of the amebic abscesses from the liver. 

Physical findings Right upper quadrant pain, hepatomegaly, and liver tenderness, with referred pain to the left or right shoulder (Note Erosion of liver abscesses may present as peritonitis)... 

Patients with severe intestinal disease or liver abscess should receive metronidazole 750 mg three times daily for 10 days, followed by the luminal agents indicated above. The pediatric dose of metronidazole is 50 mg/kg per day in divided doses, which should be followed by a luminal agent. An alternative regimen of metronidazole is 2.4 g/day for 2 days in combination with the luminal agent. Tinidazole (Tindamax, recently introduced on the United States market) administered in a dose of 2 g daily for 3 days (pediatric dose 60 mg/kg for 5 days) is an alternative to metronidazole. If there is no prompt response to metronidazole or aspiration of the abscess, an antibiotic regimen should be added. Patients who cannot tolerate oral doses of metronidazole should receive an equivalent dose intravenously. 

Follow-up in patients with amebiasis should include repeat stools (one to three), colonoscopy (in colitis) or computed tomography (CT, in liver abscess) between days 5 and 7, at the end of the course of therapy, and a month after the end of therapy. 

Those with liver abscess may take up to 7 days before there will be decreases in pain and fever. In liver abscess, patients not responding by the fifth day may require aspiration of the abscesses or exploratory laparotomy. 

Serial liver scans have demonstrated that healing of liver abscesses take from 4 to 8 months following adequate therapy. 

Whereas the highest serum IgG and IgM concentrations were found in those patients with amebic liver abscesses, their IgA levels were within normal limits. 

Amebiasis For the treatment of intestinal amebiasis and amebic liver abscess caused by Entamoeba histolytica in adults and pediatric patients older than 3 years of age. 

Metronidazole is a nitro-imidazole. It is a mixed amoebicide, i.e. it acts at all sites of infection. It has to be activated in the parasite. By reduction in the amoeba of its nitro group reactive intermediates are formed, resulting in oxidative damage and ultimately cell kill. It is effective against many parasitic intestinal and tissue infections such as trichomoniasis, giardiasis and amoebiasis. It is the drug of choice for amoebic dysentery and amoebic liver abscess. 

Therapy should be streamlined as soon as microbiological test results become available. If defervescence takes longer than a week physical and radiological examination (ultrasound or CT-scan of the abdomen) should be performed to exclude an intra-abdominal- or liver-abscess. 

Trophozoites may spread to the liver through the portal vein and produce acute amebic hepatitis, or more rarely, the trophozoites may encyst and produce an amebic liver abscess many years later. On rare occasions, amebic abscesses are found in other organs, such as the lungs or the brain. 

Long-term antibiotics such as tylosin Provided to control liver abscesses. 

Amoebiasis is an infectious disease caused by Entamoeba histolytica. It can cause asymptomatic intestinal infection, colitis (mild to moderate), dysentery (severe intestinal infection), ameboma, liver abscess etc. The drugs used in chemotherapy of amoebiasis are classified as in table 9.9.1. 

It is indicated in giardiasis, amoebic liver abscess, intestinal amoebiasis, trichomoniasis, ulcerative gingivitis, treatment and prophylaxis of anaerobic infections. 

Emetine and dehydroemetine are natural alkaloid obtained from Cephaelis ipecacuanha and synthetic analog respectively. They are effective against tissue trophozoites of . histolytica. It has no effect on cysts but effective in amoebic liver abscess also. It acts by inhibiting protein synthesis by arresting intraribosome translocation of tRNA-amino acid complex. Dehydroemetine is less toxic than emetine and very effective drug for tissue amoebiasis. It is more rapidly eliminated from the body than emetine. 

Amebiasis is infection with Entamoeba histolytica. This organism can cause asymptomatic intestinal infection, mild to moderate colitis, severe intestinal infection (dysentery), ameboma, liver abscess, and other extraintestinal infections. The choice of drugs for amebiasis depends on the clinical presentation (Table 52-5). 

Hepatic abscess, ameboma, and other extraintestinal disease Metronidazole, 750 mg 3 times daily (or 500 mg IV every 6 hours) for 10 days Dehydroemetine2 or emetine, 1 mg/kg SC or IM for 8-10 days, followed by (liver abscess only) chloroquine, 500 mg twice daily for 2 days, then 500 mg daily for 21 days... 

The treatment of choice for extraintestinal infections is metronidazole plus a luminal amebicide. A 10-day course of metronidazole cures over 95% of uncomplicated liver abscesses. For unusual cases in which initial therapy with metronidazole has failed, aspiration of the abscess and the addition of chloroquine to a repeat course of metronidazole should be considered. Dehydroemetine and emetine are toxic alternative drugs. 

Blessmann J et al Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration A comparative, prospective and randomized study. Trop Med Int Health 2003 8 1030. [PMID 14629771]... 

A 56-year-old woman with liver abscesses and tuberculous lymphadenitis was given rifampicin and 2 weeks later developed a raised thyrotropin concentration of 21... 

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