肝臓ジャーナル

概要

Amebic Liver Abscess: A New Perspective on the Prognosis of Patients in an Endemic Area Regional Referral Center

Cernichiaro-Espinosa Linda A,Segura-Ortega Jorge E,Arturo Panduro,Moreno-Luna Laura E*

Introduction: The study aims to describe the actual clinical findings, diagnostic methods, treatment, and prognosis of patients with Amebic Liver Abscess (ALA). Two decades ago, the estimated prevalence of anti-ameba antibodies with asymptomatic presentation varied from 6% to 14% in the general population of developing countries. The prevalence of symptomatic amebiasis in any form was even higher.The invasive disease was a highly morbid and common complication, with an associated mortality that varied between 1 to 26%.

Material and methods: All patients diagnosed with ALA between January 2006 and March 2012 in the regional referral center was included in the study. The diagnosis was based on: 1) clinical findings; 2) ultrasound evidence of an abscess; 3) abscess fluid with an “anchovy paste-like” appearance, negative on culture and Gram stain; and 4) response to medical treatment to metronidazole.

Results: Ultrasound of the hepatobiliary tree revealed a mean maximum diameter of 9.5 cm (range 1.4 to 28 cm). Thirty-eight (76%) patients had one abscess and 12 patients (24%) had multiple abscesses. Intravenous metronidazole were administered to all patients. Percutaneous abscess drainage (PAD) followed by ceftriaxone to prevent secondary infection was performed on 48% of patients (n=24). The abscess fluid of all patients who received PAD had an “anchovy paste-like” appearance, negative on Gram stain and culture. In this series, 100% of patients responded to metronidazole and percutaneous drainage as indicated. No patient experienced serious complications such as abscess drainage to the pleural cavity, peritoneum, pericardium or elsewhere. Average hospital stay time was 9 days (range 3 to 37 days). No patient died during or after treatment.

Discussion: The prognosis of patients with ALA has significantly improved in the last two decades. The improvement demonstrated by this study may be attributed to earlier diagnosis and earlier intervention.