Hepatic amoebiasis, diagnosis

The diagnosis of a hepatic abscess may be suspected from clinical findings. Leukocytosis will be high. Ultrasound and serology (ELISA, Latex agglutination) can confirm the diagnosis, but are often not available. Antibodies will remain present for a long time -often years- after infection. An amoebic abscess of the liver will contain necrotic liver tissue at its centre. Upon aspiration this often has a dark brownish red colour called "anchovy " or "chocolate” pus, but the pus may also be yellow, grey or greenish. The pus has no offensive odour, unlike most bacterial (anaerobic) abscesses, which is an important difference. The wall of the abscess contains trophozoites, but the necrotic liver tissue itself does not. The presence of local oedema or bulging of the skin with or without fluctuation, indicates the proximity of the abscess and the site where a puncture can be carried out. In case of doubt a trial therapy quickly produces a spectacular improvement. Fewer than 20 % of people with a hepatic abscess have Entamoeba histolytica in the faeces. The absence of amoebae in the stools is therefore not a strong argument against the diagnosis.

Category: Medicine Notes