How is liver abscess aspirate characterized 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

Liver abscess aspirate is usually an odorless thick yellow-brown liquid classically referred to as “anchovy paste.” This liquid lacks white blood cells (WBCs) as a result of lysis by the parasite. Amebae are visualized in the abscess fluid in a minority of patients with amebic liver abscess (see the image below). Liver aspiration is indicated only if abscesses are large (> 12 cm), abscess rupture is imminent, medical therapy has failed, or abscesses are present in the left lobe.


Entamoeba histolytica in liver aspirate, trichrom Entamoeba histolytica in liver aspirate, trichrome stain. Image courtesy of Centers for Disease Control and Prevention.

The aspirate can be sent for microscopy, culture, antigen detection, and PCR, where available. A Gram stain should also be performed if a pyogenic etiology is suspected clinically.


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