Association between local alcoholic beverages and amoebic liver abscess in the Indian subcontinent: Weird but true!

Kumar, Ramesh; Jha, Ashish K.

doi:10.1002/jgh3.12137

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…Previous studies from some parts of India[ 19 ] and Sri Lanka[ 20 21 ] have shown that consumption of locally made alcohol such as toddy, which is usually prepared in unhygienic conditions, is a significant risk factor for the development of ALA. No such association was found by Jha et al . [ 4 ] Alcohol consumption also causes hepatic damage, and alcoholics often have poor nutritional status leading to relative immunodeficiency state, thereby increasing the chances of ALA.[ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory profile of patients with amoebic liver abscess

Tak

Bansal

Maurya

et al. 2022

Tropical Parasitology

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Context: Amebic liver abscess (ALA) occurs in 3%–9% of the amebiasis cases, with complications seen in 20%–40% of the cases and 2%–18% mortality rate. Successful treatment thus requires the accurate identification of these cases. Aims and Objectives: We aimed to assess the seropositivity and profile of ALA patients in western Rajasthan. Materials and Methods: This retrospective study was conducted at a tertiary care center in western Rajasthan from November 2017 to May 2019. Serological diagnosis of ALA was done by detecting immunoglobulin G (IgG) antibodies in the serum of the patients by ELISA. The derangements in laboratory profile (hematological and biochemical parameters) and ultrasonography findings were assessed from the hospital records. Statistical analysis was performed using Mann–Whitney U-test. Results: Among the total cases ( n = 34), 20 were diagnosed as ALA. Twenty-one (61.8%) were positive for anti-amebic IgG antibodies. Among ALA patients, 14 (70%) were >40 years old and only 6 (30%) patients were of age ≤40 years. Male: female ratio was 5.7:1, and ultrasonography records of 15 ALA patients revealed the presence of hepatomegaly ( n = 7, 46.7%), pleural effusion ( n = 3, 20%), lung collapse ( n = 2, 13.3%), and vascular involvement ( n = 1, 6.7%). The right lobe of the liver was involved in majority of the patients ( n = 12, 80%). Total white blood cell count ( P < 0.001), absolute neutrophil count ( P = 0.001), total serum bilirubin ( P = 0.019), and serum alkaline phosphatase ( P = 0.018) were significantly elevated in ALA patients. Conclusions: Seroprevalence shows that ALA still remains the dominant etiology in liver abscess patients in this region. There are significant derangements in the laboratory profile that require a larger study for corroboration.

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Section: Discussionmentioning

confidence: 99%

Clinical and laboratory profile of patients with amoebic liver abscess

Tak

Bansal

Maurya

et al. 2022

Tropical Parasitology

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“…Interestingly, the highest consumption occurred during the dry season, which correlated to peak alcohol sales in the northern region [7,10]. 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].…”

Section: Alcohol Consumptionmentioning

confidence: 99%

“…Numerous mechanisms have been postulated to explain the link between alcohol consumption and the development of ALA. One such explanation is the 'iron hypothesis', whereby iron sequestration in the liver leads to overload, preventing alcohol metabolism via aldehyde dehydrogenase, requiring iron as a co-factor [68]. Others have suggested the role of alcohol-induced hepatocyte injury to result in reduced immunity, and thus increased susceptibility to infection due to damage of Kupffer cells [64].…”

Section: Alcohol Consumptionmentioning

confidence: 99%

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

et al. 2020

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Entamoeba histolytica (E. histolytica) is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. E. histolytica is endemic to subtropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of E. histolytica have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the Entamoeba species. As a preventable illness, E. histolytica complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of E. histolytica-induced ALA, to help address this endemic problem on the island of SLK.

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“…Strong association with alcohol consumption: Alcohol consumption increases the risk of developing ALA. A history of significant alcohol consumption is present in up to 85% of patients with ALA[ 1 , 26 , 27 ]. A number of studies from the Indian subcontinent have found a strong correlation between the incidence of ALA and the intake of local alcoholic beverages such as toddy[ 1 , 20 , 26 - 28 ].…”

Section: Clinico-epidemiological Characteristicsmentioning

confidence: 99%

“…A number of studies from the Indian subcontinent have found a strong correlation between the incidence of ALA and the intake of local alcoholic beverages such as toddy[ 1 , 20 , 26 - 28 ]. Moreover, alcoholics have been found to have larger ALA, more complications, and a longer recovery period[ 27 ]. The precise mechanism of how alcohol confers the susceptibility to ALA is yet to be defined.…”

Section: Clinico-epidemiological Characteristicsmentioning

confidence: 99%

Amebic liver abscess: An update

Kumar,

Patel,

Priyadarshi

et al. 2024

World J Hepatol

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Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica , which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.

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Association between local alcoholic beverages and amoebic liver abscess in the Indian subcontinent: Weird but true!

Cited by 4 publications

References 8 publications

Clinical and laboratory profile of patients with amoebic liver abscess

Clinical and laboratory profile of patients with amoebic liver abscess

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

Amebic liver abscess: An update

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