Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. Amebiasis, a parasitic infection caused by Entamoeba histolytica, used to be a prevalent protozoan disease in Korea, however, with an improving sanitary system, it has been among very uncommon etiology of liver abscess. A recent report suggested that ALA is an emerging parasitic infection in human immunodeficiency virus (HIV)-infected patients even in areas where the disease is not endemic and recommended HIV screening in patients in areas where ALA is not endemic, particularly those without history of travel to a disease-endemic area. We report on two patients who were admitted for treatment of ALA and then diagnosed as HIV infection. We also reviewed the etiology and characteristics of ALA in our hospital during the last 5 years.
Amebiasis ; Diagnosis* ; Entamoeba histolytica ; HIV Infections ; HIV* ; Humans* ; Korea ; Liver Abscess ; Liver Abscess, Amebic* ; Mass Screening

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. Amebiasis, a parasitic infection caused by Entamoeba histolytica, used to be a prevalent protozoan disease in Korea, however, with an improving sanitary system, it has been among very uncommon etiology of liver abscess. A recent report suggested that ALA is an emerging parasitic infection in human immunodeficiency virus (HIV)-infected patients even in areas where the disease is not endemic and recommended HIV screening in patients in areas where ALA is not endemic, particularly those without history of travel to a disease-endemic area. We report on two patients who were admitted for treatment of ALA and then diagnosed as HIV infection. We also reviewed the etiology and characteristics of ALA in our hospital during the last 5 years.
Amebiasis ; Diagnosis ; Entamoeba histolytica ; HIV Infections ; HIV ; Humans ; Korea ; Liver Abscess ; Liver Abscess, Amebic ; Mass Screening

In amebic liver abscess, communication between liver abscess and intrahepatic bile ducts is an uncommon cause of bile leak. This condition can be treated surgically or endoscopically. However, these treatment modalities are related with high morbidity and mortality. A 49-year-old man was diagnosed with amebic liver abscess. Percutaneous drainage was performed due to poor medical response and for the purpose of preventing abscess rupture. Liver abscess-biliary communication was found at follow-up imaging study. He was treated successfully with medical therapy and supportive care without further interventions.
Abscess ; Bile ; Bile Ducts, Intrahepatic ; Biliary Fistula* ; Drainage ; Follow-Up Studies ; Humans ; Liver ; Liver Abscess ; Liver Abscess, Amebic* ; Middle Aged ; Mortality ; Rupture

To identify sequences of Entamoeba histolytica associated with the development of amebic liver abscess (ALA) in hamsters, subtractive hybridization of cDNA from E. histolytica HM-1:IMSS under 2 growth conditions was performed: 1) cultured in axenic medium and 2) isolated from experimental ALA in hamsters. For this procedure, 6 sequences were obtained. Of these sequences, the mak16 gene was selected for amplification in 29 cultures of E. histolytica isolated from the feces of 10 patients with intestinal symptoms and 19 asymptomatic patients. Only 5 of the 10 isolates obtained from symptomatic patients developed ALA and amplified the mak16 gene, whereas the 19 isolates from asymptomatic patients did not amplify the mak16 gene nor did they develop ALA. Based on the results of Fisher's exact test (P<0.001), an association was inferred between the presence of the mak16 gene of E. histolytica and the ability to develop ALA in hamsters and with the patient's symptoms (P=0.02). The amplification of the mak16 gene suggests that it is an important gene in E. histolytica because it was present in the isolates from hamsters that developed liver damage.
Adolescent ; Animals ; Cricetinae ; Entamoeba histolytica/*genetics ; Gene Expression ; *Genes, Protozoan ; Genetic Association Studies ; Humans ; Liver Abscess, Amebic/*genetics/*parasitology ; Male ; Virulence Factors/*genetics ; Young Adult

BACKGROUND/AIMS: Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay. METHODS: A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records. RESULTS: A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care. CONCLUSIONS: Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis.
Amebicides/therapeutic use ; Cholesterol/metabolism ; *Entamoeba histolytica ; Female ; Humans ; Hypercholesterolemia/blood/*parasitology ; Length of Stay ; Liver Abscess, Amebic/blood/*complications/drug therapy ; Male ; Middle Aged ; Treatment Outcome

Amebic liver abscess (ALA) has been diagnosed in travelers to endemic areas or in patients with immunosuppression secondary to human immunodeficiency virus infection since the late 1990s. Further, it is a rare disease in Korea. ALA should be considered in patients present with fever and right upper quadrant pain along with a risk of exposure to amebiasis. We report an 82-year-old man with symptoms of fever, gross hematuria and severe renal impairment as having amebic liver abscess complicated with the obstruction of the inferior vena cava. Amebic liver abscess was successfully treated with antibiotics alone. Also, hematuria disappeared and renal dysfunction improved after treatment.
Aged, 80 and over ; Amebiasis ; Anti-Bacterial Agents ; Fever ; Hematuria ; HIV ; Humans ; Immunosuppression ; Korea ; Liver Abscess, Amebic* ; Rare Diseases ; Renal Insufficiency ; Vena Cava, Inferior*

OBJECTIVETo compare the efficacy of three different tissue stains, namely haematoxylin and eosin (H&E), periodic-acid Schiff (PAS) and immunohistochemical (IHC) stains for detection of Entamoeba histolytica (E. histolytica) trophozoites in abscessed liver tissues of hamster.

METHODSAmoebic liver abscess was experimentally induced in a hamster by injecting 1 × 10(6) of axenically cultured virulent E. histolytica trophozoites (HM1-IMSS strain) into the portal vein. After a week post-inoculation, the hamster was sacrificed and the liver tissue sections were stained with H&E, PAS and IHC stains to detect the amoebic trophozoite.

RESULTSThe three stains revealed tissue necrosis and amoebic trophozoites, but with varying clarity. H&E and PAS stained the trophozoites pink and magenta, respectively, however it was difficult to differentiate the stained trophozoites from the macrophages because of their similarity in size and morphology. On the other hand, IHC stain revealed distinct brown appearance of the trophozoites in the infected liver tissues.

CONCLUSIONSIt can be concluded that out of the three stains, IHC is the best for identification of E. histolytica trophozoites in tissue sections.

Animals ; Disease Models, Animal ; Entamoeba histolytica ; cytology ; isolation & purification ; Histocytochemistry ; methods ; Immunohistochemistry ; methods ; Liver Abscess, Amebic ; diagnosis ; pathology ; Male ; Mesocricetus ; Microscopy ; Parasitology ; methods ; Staining and Labeling ; methods ; Trophozoites ; cytology

Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection.
Abdominal Pain ; Abscess ; Amoeba ; Ascites ; Colitis ; Diagnosis, Differential ; Diagnostic Errors ; Diarrhea ; Dysentery, Amebic ; Eosinophils ; Humans ; Inflammatory Bowel Diseases ; Liver ; Liver Abscess ; Male ; Steroids

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.
Anti-Bacterial Agents/therapeutic use ; Antibodies, Protozoan/analysis ; Entamoeba/immunology/isolation & purification ; Enzyme-Linked Immunosorbent Assay ; Humans ; Liver Abscess, Amebic/complications/*diagnosis/ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thrombosis/diagnosis/etiology ; Tomography, X-Ray Computed ; Vascular Diseases/*etiology ; *Vena Cava, Inferior ; Young Adult

Recent studies indicate that there is an increased risk of amebic liver abscess among those infected with HIV, which is associated with cell-mediated immunosuppression. Although Entamoeba histolytica infection is common among HIV infected patients, only a few cases of amebic liver abscess with bilateral pleural effusion have been reported. We present a case of a 44-year-old man who presented with fever and right lower quadrant abdominal pain. Amebic liver abscess with bilateral pleural effusion was confirmed by serologic test, clinical symptoms, and radiological findings. HIV infection was incidentally diagnosed during treatment. The possibility of the presence of amebic liver abscess should be considered in HIV infected patients with space-occupying lesions in the liver, and HIV screening should strongly be recommended in patients with amebic liver abscess.
Abdominal Pain ; Adult ; Entamoeba histolytica ; Fever ; HIV ; HIV Infections ; Humans ; Immunosuppression ; Liver ; Liver Abscess, Amebic ; Mass Screening ; Pleural Effusion ; Serologic Tests