Amebic Liver Abscess Diagnosed by Polymerase Chain Reaction in 14 Returning Travelers

Vallois, D.; Epelboin, Loïc; Bricaire, François; Caumes, Éric; Touafek, Fériel; Magne, Denis; Thellier, Marc

doi:10.4269/ajtmh.2012.12-0366

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…Haematological findings such as leukocytosis, elevated ESR and ALP were also comparable to those described previously [16–19, 22–27]. To facilitate the diagnosis, laboratory investigations play a major role.…”

Section: Discussionsupporting

confidence: 85%

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

et al. 2017

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BackgroundSince 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial.MethodsAll clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson’s medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced.ResultsFrom July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results.ConclusionTo our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.

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Section: Discussionsupporting

confidence: 85%

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

et al. 2017

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“…In France, one single study assessed treatment options for imported ALA and proposed an algorithm for drainage procedures [3]. Size of ALA is determined by radiology and is in most cases between 5 and 10 cm [2], [3], [4], [5]. Nevertheless, no factor has been identified as showing a correlation with the size of the abscess up to date.…”

Section: Introductionmentioning

confidence: 99%

Imported Amoebic Liver Abscess in France

et al. 2013

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BackgroundWorldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers.MethodsWe performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model.ResultsWe investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5∶1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p<0.01), aged more than 41 years old (OR = 3.63, p = 0.02) and being an immigrant (OR = 11.56, p = 0.03). Percutaneous aspiration was not based on initial abscess size but was carried out significantly more often on patients who were admitted to surgical units (OR = 10, p<0.01). The median time to abscess disappearance for 24 ALA was 7.5 months.Conclusions/SignificanceIn this study on imported ALA was one of the largest worldwide in terms of the number of cases included males, older patients and foreign-born patients presented with larger abscesses, suggesting that hormonal and immunological factors may be involved in ALA physiopathology. The long lag time before developing ALA after returning to a non-endemic area must be highlighted to clinicians so that they will consider Entamoeba histolytica as a possible pathogen of liver abscesses more often.

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“…Currently, the available literature regarding ALA in travelers is limited to case series from France 4,9 and in one study diagnostic molecular biology techniques were applied. 8 In the present study, 14 of 6,867 (0.2%) ill returning Israeli travelers were diagnosed with ALA. Fifty-three of these ill returning travelers presenting to the travel medicine clinic were diagnosed with amebiasis which implies that 26% of symptomatic amebiasis travelers developed invasive ALA. This relatively high proportion of ALA may reflect the decrease in the denominator, which may reflect the better differentiation of E. histolytica from the other nonpathogenic species and/or the assumption that mild cases of amebiasis do not reach medical attention post travel.…”

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confidence: 99%

“…Detailed case series of imported ALA exist but they exclusively originate from France. 4,8,9 The aim of our study is to describe the presentation, clinical course, and to point out new aspects of ALA in travelers.…”

Section: Introductionmentioning

confidence: 99%

“…In the three travel-related French case series of ALA immigrants, foreign workers were not excluded and the reported male to female ratio is between 2.3:1 and 3.5:1, 4,8,9 which shows male predominance but much less prominence in comparison to the ratios given in endemic countries. The male to female ratio among all French travelers to endemic countries is not given; therefore, theoretically significantly more males traveling might be the reason for the male predominance.…”

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confidence: 99%

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Amebic Liver Abscess in Israeli Travelers: A Retrospective Study

Lachish

Wieder‐Finesod

Schwartz

2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Amebic liver abscess (ALA) is endemic in developing countries. The epidemiology and clinical characteristics of the disease in developing countries are well described. Travelers from nonendemic countries can serve as a model for the natural history of ALA. Currently, the available literature on travelers is limited. This is a retrospective observational study on Israeli travelers diagnosed with ALA. Data regarding travel history, clinical presentation, imaging, and treatment were collected and analyzed. Among 6,867 ill returning Israeli travelers, amebiasis was diagnosed in 53 travelers (0.77%), of whom 14 were with ALA (0.2%). Twelve ALA cases (86%) had an exposure in the Indian subcontinent. The male to female ratio was 1:1, with no significant clinical differences between the sexes. The average lag period between exposure and onset of symptoms was 17.1 months. The lack of male predominance and the prolonged lag period may imply that behavioral factors are pivotal in the development of ALA. Larger case series of travelers are required.

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Amebic Liver Abscess Diagnosed by Polymerase Chain Reaction in 14 Returning Travelers

Cited by 17 publications

References 28 publications

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

Imported Amoebic Liver Abscess in France

Amebic Liver Abscess in Israeli Travelers: A Retrospective Study

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