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PubMed1975

Comparison of metronidazole and chloroquine for the treatment of amoebic liver abscess. A controlled trial.

Chloroquine and metronidazole were compared in a randomized trial for the treatment of amoebic liver abscess in 36 patients. An additional 30 patients were treated without randomization. Chloroquine was given according to the standard protocol at Los tangeles County-University of Southern California Medical Center, which is 500 mg daily for 10 weeks, whereas metronidazole was given in a dose of 750 mg three times daily for 10 days. Criteria for the diagnosis of amoebic abscess included (a) a suitable clinical picture, (b) filling defect on hepatic scan, (c) high titer of antibody to Entamoeba histolytica by indirect hemagglutination, and (d) eventual complete recovery with treatment or appropriate findings on autopsy examination. Treatment failure, defined as illness that persisted beyond 10 days or recurred after that time, occurred in 1 of 28 patients treated with chloroquine and in 2 of 36 treated with metronidazole. In 2 patients who died it was difficult to assess the result of drug therapy. We conclude that both drugs are highly effective. Metronidazole has the advantage of effectiveness against intestinal amoebiasis and the probability of cure with a shorter course of treatment. Speed of response was slightly greater with metronidazole and was somewhat related to abscess size.

Adolescent↗
PubMed1990

Amoebic liver abscess: the effect of aspiration on the resolution or healing time.

Recent sonographic monitoring of patients treated for amoebic liver abscess has shown the healing or resolution time varying between 10 and 300 days. The effect of percutaneous needle aspiration under or resolution time was studied in 36 patients. Nineteen patients had drugs and needle aspiration under ultrasound guide whilst the 17 patients had drugs--metronidazole, diloxanide, and chloroquine--alone. Both groups were monitored clinically and sonographically. Results showed that the abscess cavities of 18 out of 19 patients (94.7%) of the aspirated group and 10 of 17 patients (58.8%) of the non-aspirated group had resolved at the end of three weeks. The difference in response to treatment was significant (P less than 0.02) more so for lesion size more than 6 cm (P less than 0.01). There was also a more rapid clinical response in the aspirated group than in the non-aspirated group, particularly for patients whose lesion size was more than 6 cm (P less than 0.01). In conclusion, percutaneous needle aspiration is safe, enhances clinical recovery, and accelerates resolution particularly in patients with large abscess cavities.

Adult↗
PubMedDate not supplied

[Amebic liver abscess: clinical and therapeutic considerations].

The authors report the case of a young adult with an amebic liver abscess. The primary infection localized in the gut occurred during a vacation in Africa. This disorder is fairly uncommon in western countries which is why the authors considered it worthwhile to draw practitioners' attention to it, stressing that it should be taken into account in differential diagnosis of fever of unknown origin in young adults who have travelled to regions where amebiasis is endemic. In addition, the diagnostic procedures used and especially the treatment applied are briefly set out. Medical therapy is almost always successful but if significant improvement is not achieved within a reasonable lapse of time and if complications are suspected, all possible therapeutic measures, including surgery, must be applied.

Adult↗
PubMed1993

Axenic cultivation of Entamoeba histolytica from liver abscess and its zymodeme.

A local strain of Entamoeba histolytica, the HTH-56: MUTM from a human liver abscess was successfully axenized. The culture was initially established monoxenically in Diamond's TYI-S-33 medium in the presence of Crithidia luciliae and maintained at 34 +/- 0.5 degrees C. After 5 passages it was adapted to axenic cultivation by addition of 0.02% Bacto agar in Diamond's TYI-S-33 medium in place of Crithidia. Subcultures or replacement with fresh complete media were done twice or thrice for 7 days, after which the agar was omitted and a stable culture was obtained. Isoenzyme analysis showed that this strain of E. histolytica belonged to the zymodeme II pattern, which is one out of 10 pathogenic zymodemes of E. histolytica most commonly found among the virulent strains.

Animals↗
PubMedDate not supplied

[Protein electrophoresis and immunoglobulin concentration in the serum of children with amebic liver abscess].

The concentration of immunoglobulins G and M plus the electrophoretic profile of proteins was studied in the serum of 14 children with amebic liver abscess. There were different degrees of weight loss and of liver necrosis in all of them. The concentration of total proteins of the serum was subjected to different factors and resulted with wide individual variations. The same was obtained when the values of the fractions separated by electrophoresis were expressed in g/dl. On the other hand, percentual values gave a similar profile for all of the patients. Besides the significant increases of IgG. an inversion of the albumin/globulins ratio was found and an increase of the percentages of alpha-1, alpha-2 and gamma fractions. The importance that proteolytic anti-enzyme mechanisms may bear in the evolution of the lesion brought about in the liver by the enzymes liberated by the protozoa, is speculated.

Blood Protein Electrophoresis↗
PubMed1989

Patterns of gallium uptake in amebic liver abscesses.

Imaging with Ga-67 and Tc-99m sulfur colloid was performed in ten patients with amebic liver abscesses. The most common imaging pattern appeared to be with the sharp identification of a "rim" sign on delayed Ga-67 imaging, from 48-72 hours.

Citrates↗
PubMed1979

Amebic liver abscess in children: clinical and epidemiologic features.

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission predominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.

Adolescent↗
PubMed1982

[Amebic liver abscess: ultrasound and clinical follow-up of 20 patients].

A retrospective analysis of 20 patients with amoebic liver abscesses was performed. Seven of 20 patients had more than one abscess. In all, 33 separate abscesses were observed. The diagnosis was based on clinical findings such as malaise, fever, abdominal discomfort, and pain in the right abdomen, haematological and serological anomalies, such as leukocytosis, elevated erythrocyte sedimentation rate, and slightly elevated liver enzymes. The serological investigation included complement fixation, indirect haemagglutination, and latex fixation test, this latter test produced strong reactions in all patients with acute symptoms. The typical ultrasonographic pattern resembled that of a minor echogenic lesion at the time of diagnosis and initiation of therapy. However, in a few acutely ill patients the lesions could not be identified by ultrasonography on first examination, but were clearly identifiable on second investigation on the following days. This finding has not been published previously. It may be observed in a very early stage of the disease only and is, therefore, dependent on rapid diagnosis of amoebiasis. During the follow-up investigations of three months to one year, the majority of abscesses could still be identified.

Amebicides↗