What are the signs and symptoms of liver abscess in amebiasis?

Updated: Jul 19, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Amebic liver abscess is the most common form of extraintestinal amebiasis. [45] It occurs in as many as 5% of patients with symptomatic intestinal amebiasis and is 10 times as frequent in men as in women. Approximately 80% of patients with amebic liver abscess present within 2-4 weeks of infection. An estimated 95% of amebic liver abscesses related to travel develop within 5 months, though some may not manifest until years after travel to or residency in an endemic area.

The most typical presentation of amebic liver abscess is fever (in 85-90% of cases, in contrast to amebic colitis), right upper quadrant pain, and tenderness of less than 10 days’ duration. Involvement of the diaphragmatic surface of the liver may lead to right-side pleuritic pain or referred shoulder pain. Acute abdominal symptoms and signs should prompt rapid investigation for intraperitoneal rupture.

Associated gastrointestinal (GI) symptoms occur in 10-35% of patients and include nausea, vomiting, abdominal distention, diarrhea, and constipation. Approximately 40% of patients who have amebic liver abscess do not have a history of prior bowel symptoms. Although 60-70% of patients with amebic liver abscess do not have concomitant colitis, a history of dysentery within the previous year may be obtained. In a 2014 study of routine colonoscopy in patients with amebic liver abscess, colonic involvement was noted in two thirds of cases. [46] When colon was involved, right colonic lesion was universally present.

A small subset of patients with amebic liver abscess have a subacute presentation with vague abdominal discomfort, weight loss or anorexia, and anemia. Jaundice is unusual. Cough can occur. A history of alcohol abuse is common, but whether a causal relation exists is unclear.


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