Amoebic Hepatic Abscesses in an HIV-Positive Patient

Abstract

Herein we report the case of hepatic amoebic abscesses in an HIV-positive Italian seaman with a history of promiscuous heterosexual intercourse. In October 2004, the patient was hospitalized because of fever and recurring abdominal pain. Abdominal ultrasonography revealed six hepatic hypoechoid oval lesions with hyperechoid margins. Stool samples were negative for parasites and bacteria, and serology for Entamoeba histolytica was also negative. Therapy with meropenem plus levofloxacin was initiated. After a partial resolution of clinical symptoms and reduction of three hepatic lesions, the patient was again hospitalized in December 2004, because of recurring intense pain at the right hypochondrium and fever. At this time, one hepatic lesion at the sixth segment was enlarged, two lesions were unchanged, and the remaining three smaller abscesses were resolved. Serum antibodies for E. histolytica and amoebic antigens on the largest abscess drainage were positive; moreover, E. histolytica was also identified on drainage fluid with polymerase chain reaction (PCR). Therapy with metronidazole followed by paromomycin improved both symptoms and radiographic images. This case report suggests that in HIV-infected patients, invasive amoebiasis should be considered and atypical aspects, such as multiple hepatic lesions, delayed positivity of serology for E. histolytica, and possible bacterial superinfection should be evaluated.

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

“…Generally, when clinical symptoms develop they are limited to the gastrointestinal tract. However, the likelihood of developing invasive amoebiasis is increased in the presence of HIV infection (144)(145)(146)245), with higher rates of amoebic colitis (144,213) and amoebic liver abscesses (35,142,160) reported. Furthermore, seroprevalence studies, which are considered a sensitive marker of previous invasion, suggest that immunosuppression increases the risk of disseminated disease, with significantly higher rates of antibody positivity in HIV-positive patients (50,269).…”

Unusual multiple large abscesses of the liver: interest of the radiological features and the real-time PCR to distinguish between bacterial and amebic etiologies

“…7,[11][12][13][14][15][16][17][18] Besides, in all these studies, multiples abscesses preferentially occurred in concomitant immunocompromised patients, e.g. HIV-infection, 19,20 or in cases of advanced amebiasis, e.g. in subjects exposed to recurrent amebic infections.…”

Liver Abscess Due to Fusobacterium necrophorum in an Immunocompetent Patient

“…Cases of amebic hepatic abscess are reported also in developed countries, including Italy. 5,7 For this reason, a suspicion of an amebic infection was initially made. Laboratory results showed the presence of F. necrophorum in the fluid drained from liver.…”

“…Detection of amebic antigens (E. histolytica antigen enzyme-linked immunosorbent assay; Novum Diagnostica, Germany) was also negative on 3 fecal samples and on the hepatic abscess drainage. In addition, the drainage sample was sent to the Istituto Superiore di Sanità, Rome, Italy where a polymerase chain reaction for E. histolytica was performed as previously described 5 with a negative result.…”