We have come across hundreds of amoebic liver abscess cases here in northern Sri Lanka. We treat all of them with metronidazole and sometimes with percutaneous aspiration. All of them recover. But we don't have any laboratory tests to confirm amoebiasis objectively.
Patient with amoebic liver abscess has hight titres of the antibodies in his blood.
My recommendation is confirmation using serology.
Yours sincerely,
Pavel Chalupa
Agree. If possible, sera obtained at two time points, normally tested by ELISA, showing increase in OD. Of course one sample is enough if ODs are high at the point of Dx.
Hope the above helps.
Aura Andreasen
I have never seen an amoebic liver abscess. Could you share some pictures or/and cases from your practice here, please?
The liver abscess can be due to ALA, pyogenic liver abscess, or mixed infections. The use of metronidazole and/or abscess drainage is the routine management for this clinical presentation. For confirmation of diagnosis, abscess culture for bacteria and serological test for amoebiasis can be performed.
Back to the main point, the best test for confirmation of ALA is DNA detection of E. histolytica in abscess. If abscess drainage is impossible, antibody detection is the second best choice.
PCR is great for differential diagnosis in cases where drainage is indicated, and it is available but if looking to confirm retrospectively, then serology is best.
PCR is best. If you can not get sample, serological test is second choice.
PCR test is the most sensitive one. But if the patient has undergone treatment for certain time, the DNA in abscess might have degraded. The amount of DNA will decrease. So, it is good to use real time PCR, which is currently the most sensitive test, to ensure the accuracy.
Agreed with colleagues - PCR -is good. And also microscopy pus evaluation after fine-needle aspiration.
Practically speaking as you are working in an endemic area, and almost all of the cases with hepatic abscess are amoebic, you will rather face problems with the non-amoebic cases than with the amoebic ones. As you mentioned all of your patients recovered after metronidazole therapy. This will not occur if the disease is caused by microorganisms which are usually responsible for liver abscess formation in the Western world. And for clinical purposes it seems unnecessary to prove formally amoebiasis in your practice – it will just add some additional costs. However if your question is related to some research – there are several diagnostic markers for amoebiasis, both commercially available and under research, all of them with some limitations regarding their sensitivity and specificity. Look at Pubmed – there are hundreds of papers discussing various diagnostic tests for amoebiasis.
Before a punction, perhaps a serologic test is important. To confirm the presence of E. histolytica, the PCR test is the best.
According to my experiens (former soldiers from Afganistan) - the pus from abscess microscopy delivered by fine-needle aspiration under ultrasound control.
Aspiration of pus to see trophozoite form of E. histolutica. Another test may be liver US & detection of serum antigen of E. histolytica.
Yes. But light microscopy of pus, delivered from abscess is very good test.
Dear Bruce Imbert
Thank you so much for that comprehensive explanation.
Anti gal nac plus gal nac antigen before treatment is simple best combination
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases