Amoebic Liver Abscess and Indigenous Alcoholic Beverages in the Tropics

Abstract

Amoebic liver abscess (ALA) seen commonly in the tropics is predominantly confined to adult males, especially those who consume locally brewed alcohol, although intestinal amoebiasis occurs in all age groups and in both genders. Whether the role of alcohol in the development of ALA is incidental and casual or whether alcohol is causally implicated has been debated. It has been argued that socioeconomic factors and poor sanitary conditions are the primary culprits that casually link alcohol to ALA. However, there has emerged an abundance of data that implicates alcohol in a more causal role in facilitating the extraintestinal invasion of the infective protozoan and the subsequent development of ALA. These factors include the role of alcohol in host immunity, parasitic proliferation, and invasion and in creating a conducive hepatic microenvironment. The contributory role of alcohol-induced increase in hepatic iron stores and lipid content is discussed. Late-stage liver disease with fibrosis seems to be protective for the development of ALA. Further research is necessary to elucidate the many possible mechanisms that predispose to hepatic amoebiasis, so that appropriate individual and population-based preventive measures can be implemented.

The iron and testosterone levels in amoebic liver abscess patients - a preliminary study from northern Sri Lanka

“…This finding contradicts with a laboratory-based study that found testosterone increased the susceptibility of mice to Entamoeba histolytica liver abscess by reducing the interferon-gamma secretion by natural killer cells but human studies are lacking. 11 A further, well designed prospective cohort study would be favorable to explore this observation. It has been suggested, based on animal models (hamster), that the male hormone testosterone could be a host factor that favors the development of ALA. 4 The positive role of testosterone could be one of the explanations that middle-aged men were mostly affected, with ALA reaching a peak by the age of 40 years.…”

Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem

“…Ultimately, the progression to symptomatic disease is dependent on a multitude of factors including gut microbiome composition, dysbiosis, hosts' age, hosts' genetic composition, immunogenicity (i.e., reduced cellmediated immunity), and the unique interaction between host-immunity and parasitic virulence. These have been shown to be a predictor of disease severity [9,[52][53][54][55], and are discussed in Fig. 1 below.…”

“…The first published report of E. histolytica in Sri Lanka dates back to 1962 [7]. Since then, numerous studies have highlighted the burden of this disease as a major public health concern [6,7,9,11,47]. In 1985, ALA accounted for 5.9% of total admissions at the Teaching Hospital Jaffna (THJ) [4].…”

“…Currently, data supports an association between the consumption of indigenous alcoholic beverages and ALA [64,68]. While it is unclear how E. histolytica enters the alcoholic beverages prior to consumption to cause disease, theories suggest that it may be due to factors such as water contamination, unhygienic practices in toddy taverns such as open-air defecation, improper hand hygiene, and water filtration practices (cysts are resistant to low doses of chlorination) [9,69].…”

“…In addition to being a significant cause of protozoal diarrhea and dysentery, E. histolytica is also the most common cause of amoebic abscesses [3]. This pathogen is endemic to tropical countries, such as Sri Lanka (SLK) and has been a major parasitological health concern on the island since 1962 [4][5][6][7][8][9]. Overall, the incidence of amoebiasis and ALA have declined significantly in other parts of the island [10] but remains a common cause of emergency department (ED) admission in the north [6,11].…”