Imported Amoebic Liver Abscess in France

Abstract

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.

Imported Skin Infections from Tropical Regions by Travelers and Immigrants to the Belgian Mosan Region

“…The incidence of obvious tropical skin infections is likely to be quite low in immigrants as a whole. By contrast, in unregistered alien children, the prevalence of multiple parasites [38][39][40] tinea capitis and impetiginized dermatoses [41] , is probably high in some instances. Immigrants who floe from wars are quite different.…”

Amebic Liver Abscess in Israeli Travelers: A Retrospective Study

“…1 In the developing world, because of poor sanitation and inadequate health education, amebiasis is still a main health concern, 2 while in developed countries the disease is rare and most cases are imported by immigrants or international travelers. 3,4 According to the World Health Organization, amebiasis is defined as infection with E. histolytica, regardless of the symptoms. 5 Up to 90% of amebiasis cases are asymptomatic.…”

“…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.…”

“…18 In contrast, in a recent case series of imported ALA cases to France only 19% of the cases originated from Asia (specific country of acquisition is not given) and the vast majority of the cases were imported from Africa (56%). 4 This difference is probably due to the destination preference of Africa by the French travelers. 19 A surprising finding in our results is the lack of male predominance among patients with ALA.…”

“…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.…”