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Liver Abscess Caused by Entamoeba histolytica

Arief Zamir


Liver Abscess due to Entamoeba histolytica mostly occurs in many

developing countries. That is because its infection is transmitted

through food or water with low hygiene, that may contains the cyst of the parasite.

Liver involvement occurs following invasion of the protozoa into mesenteric venules. Amoebae than enter the portal circulation and travel to the liver where they typically form large abscess.


Entamoeba histolytica is an anaerobic parasitic protozoan, part of

genus Entamoeba. It infects predominantly humans and other

primates. It has a relatively simple life cycle that alternates between trophozoite and cyst stages. The trophozoite is the actively

metabolizing, mobile stage, and the cyst is dormant and

environmentally resistant.

Ingested cysts of Entamoeba histolytica excyst in the small intestine.

Trophozoites are carried to the colon, where they mature and

reproduce. The parasite may lead a commensal existence on the mucosal surface and in the crypts of the colon

Amoebic dysentery usually occurs gradually, with symptoms : abdominal pain and tenderness, painful sudden bowel evacuation (tenesmus) and diarrhoea

that develop over a period of one to several weeks, often followed by weight loss

When the mucosal involvement becomes extensive, diarrhea is replaced by dysentery, with the passage of exudates, blood and


Diagnosis is by doing direct fecal smear and staining. The others such as Enzyme Immuno Assay (EIA), Antigen detection, Polymerase Chain Reaction (PCR) is for species identification.

Metronidazole, or related drug such as Tinidazole and Ornidazole is the treatment for the trophozoite that have invaded tissue, and followed by luminal amebicide, such as Paramomycine, Diloxanide

Furoat, and Iodoquinol, for treating intestinal infection.


The cysts of Entamoeba histolytica are transmitted primarily by food and water contamination. While it can cause dysentery when living in the intestinal, it can also manifested to liver abscess by entering mesenteric venule then go to portal vein and last remain in the liver,

where they typically form large abscess.

The right lobe of the liver is more commonly affected than the left lobe. This has been attributed to the fact that the right lobe is supplied predominantly by the superior mesenteric vein, whereas the left lobe is supplied by the splenic vein

The sign and symtomps of liver abscess include :


Abdominal pain, and may radiate to the right shoulder or scapular Fever

cough and chest pain Hepatomegaly Jaundice Nausea and vomiting Weight loss

Diagnose can be confirmed by lab studies include stool examination, which finding the cyst of the parasite,or other test such as stool antigen detection, stool culture, and serologic test.

Imaging test, for example Ultrasonography (USG), can be an option to see the condition of the liver .

Tissue amebicides are used to eradicate the invasive trophozoite forms in the liver : - Metronidazole - Emetine, - Tinidazole, - Dehydroemetin

Additional drug may be given; Chloroquine that active only in the liver; Tetracycline acts on the bowel wall

And luminal agents, such as : Diloxanide Furoate Paramomycine Iodoquinol

to eradicate the intestinal carriage after the amebic liver abscess has been treated with one of the above tissue amebicides

Surgical care such therapeutic aspiration must be considered in amebic liver abscess in the following situations:

(1) high risk of abscess rupture, as defined by cavity size greater than 5 cm;

(2) left lobe liver abscess, which is associated with higher mortality and frequency of peritoneal leak or rupture into the pericardium;
(3) failure to observe a clinical medical response to therapy within 5-7 days


Amebic liver abscess, as the most frequent extraintestinal manifestation of Entamoeba histolytica (amebiasis), can affect all people from all races, and mostly in developing countries in the tropics. The risk factors for infection include travel or residence in

endemic areas.

The best way is to prevent it from affecting us. It can be done by avoiding contaminated food or drinks that may contain the cyst of Entamoeba histolytica by keeping the hygiene and sanitary of environment.

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7. Amoebic Liver disease. Available at: Amoebic_liver_abscess