Opinion statement
Amebic liver abscess should be suspected in travelers returning from endemic areas or in immunocompromised patients who present with fever, right upper quadrant pain, hepatomegaly, and a liver lesion on an imaging study. Rapid initiation of therapy without serologic confirmation of infection, if necessary, is important to minimize complications. Metronidazole is given orally or intravenously for 14 days. The drug is generally well tolerated and leads to resolution of symptoms in most patients within 2 to 3 days. It is effective against luminal cysts in only 50% of patients and, therefore, must be followed by a course of treatment with paromomycin (Humatin; Parke-Davis, Morris Plains, NJ) or another luminal antiamebic agent to eradicate the parasite. Image-guided drainage of an amebic liver abscess is indicated in patients who do not respond to antimicrobial therapy or who are at risk of abscess rupture. Surgery is reserved for patients with a ruptured abscess. Although medical therapy is generally successful in the treatment of infection caused by Entamoeba histolytica, the development of potent vaccines will be needed for worldwide eradication of disease attributable to E. histolytica.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Akgun Y, Tacyildiz IH, Celik Y: Amebic liver abscess: changing trends over 20 years. World J Surg 1999, 23:102–106.
World Health Organization: The World Health Report 1995. Bridging the gaps. Geneva, Switzerland: World Health Organization; 1995.
Stanley SL: Pathophysiology of amoebiasis. Trends Parasitol 2001, 17:280–285. Excellent review on the pathophysiology of intestinal amebiasis and amebic liver abscess.
Mehta RB, Parija SC, Chetty DV, Smile RR: Management of 240 cases of liver abscess. Int Surg 1986, 71:91–94.
Seeto RK, Rockey DC: Amebic liver abscess: epidemiology, clinical features, and outcome. West J Med 1999, 170:104–109. Recent case series of 56 patients with good overview of clinical presentation and findings, as well as management strategies in patients with amebic liver abscess.
Hoffner RJ, Kilaghbian T, Esekogwu VI, Henderson SO: Common presentations of amebic liver abscess. Ann Emerg Med 1999, 34:351–355. Case series of 75 patients emphasizing the typical presenting symptoms and findings in patients with amebic liver abscess.
Hughes MA, Petri WA, Jr. Amebic liver abscess. Infect Dis Clin North Am 2000, 14:565–582. Excellent review of all aspects of amebic liver abscess with detailed section on treatment options.
Shandera WX, Bollam P, Hashmey RH, et al.: Hepatic amebiasis among patients in a public teaching hospital. South Med J 1998, 91:829–837.
Sharma MP, Dasarathy S, Verma N, et al.: Prognostic markers in amebic liver abscess: a prospective study. Am J Gastroenterol 1996, 91:2584–2588.
Petri WA, Jr, Singh U: Diagnosis and management of amebiasis. Clin Infect Dis 1999, 29:1117–1125.
Sathar MA, Simjee AE, Nel JD, et al.: Evaluation of an enzyme-linked immunosorbent assay in the serodiagnosis of amoebic liver abscess. S Afr Med J 1988, 74:625–628.
Haque R, Mollah NU, Ali IK, et al.: Diagnosis of amebic liver abscess and intestinal infection with the TechLab Entamoeba histolytica II antigen detection and antibody tests. J Clin Microbiol 2000, 38:3235–3239.
Zaman S, Khoo J, Ng SW, et al.: Direct amplification of Entamoeba histolytica DNA from amoebic liver abscess pus using polymerase chain reaction. Parasitol Res 2000, 86:724–728.
Evangelopoulos A, Spanakos G, Patsoula E, et al.: A nested, multiplex, PCR assay for the simultaneous detection and differentiation of Entamoeba histolytica and Entamoeba dispar in faeces. Ann Trop Med Parasitol 2000, 94:233–240.
Kimura K, Stoopen M, Reeder MM, Moncada R: Amebiasis: modern diagnostic imaging with pathological and clinical correlation. Semin Roentgenol 1997, 32:250–275.
Li E, Stanley SL, Jr: Protozoa. Amebiasis. Gastroenterol Clin North Am 1996, 25:471–492.
Irusen EM, Jackson TF, Simjee AE: Asymptomatic intestinal colonization by pathogenic Entamoeba histolytica in amebic liver abscess: prevalence, response to therapy, and pathogenic potential. Clin Infect Dis 1992, 14:889–893.
Sharma MP, Ahuja V: Management of amebic liver abscess. Arch Med Res 2000, 31:S4-S5.
Hanna RM, Dahniya MH, Badr SS, El-Betagy A: Percutaneous catheter drainage in drug-resistant amoebic liver abscess. Trop Med Int Health 2000, 5:578–581.
Ralls PW: Focal inflammatory disease of the liver. Radiol Clin North Am 1998, 36:377–389.
Moazam F, Nazir Z: Amebic liver abscess: spare the knife but save the child. J Pediatr Surg 1998, 33:119–122.
vanSonnenberg E, Mueller PR, Schiffman HR, et al.: Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage. Radiology 1985, 156:631–635.
Baijal SS, Agarwal DK, Roy S, Choudhuri G: Complex ruptured amebic liver abscesses: the role of percutaneous catheter drainage. Eur J Radiol 1995, 20:65–67.
Ken JG, vanSonnenberg E, Casola G, et al.: Perforated amebic liver abscesses: successful percutaneous treatment. Radiology 1989, 170:195–197.
Greaney GC, Reynolds TB, Donovan AJ: Ruptured amebic liver abscess. Arch Surg 1985, 120:555–561.
Stanley SL Jr: Progress towards development of a vaccine for amebiasis. Clin Microbiol Rev 1997, 10:637–649.
Petri WA, Ramakrishnan G: Applying antisense technology to the study of Entamoeba histolytica pathogenesis. Trends Microbiol 1999, 7:471–474.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Goessling, W., Chung, R.T. Amebic liver abscess. Curr Treat Options Gastro 5, 443–449 (2002). https://doi.org/10.1007/s11938-002-0032-z
Issue Date:
DOI: https://doi.org/10.1007/s11938-002-0032-z