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  • • Etiologies include:

    • -Amebic

      -Echinococcal

      -Schistosomal

    • Risk factors for amebic abscess:

    • -HIV

      -Travel to high prevalence area

      -Alcoholism

    • Hydatid cysts:

    • -Liver (50-70% of cases)

      -Lung (20-30% of cases)

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Epidemiology

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  • • Schistosomal infection major cause of portal hypertension worldwide

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Symptoms and Signs

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  • • Fever

    • Right upper quadrant pain

    • Jaundice

    • Dyspnea

    • Diarrhea in 33% with amebic abscess

    • Anaphylaxis (hydatid cyst)

    • Palpable hepatic mass (hydatid cyst)

    • For schistosomal disease:

    • -Maculopapular rash

      -Lassitude

      -Anorexia

      -Diarrhea

      -Headache

      -Fevers

      -Hepatomegaly

      -Splenomegaly

      -Lymphadenopathy

      -Variceal hemorrhage

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Laboratory Findings

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  • • Leukocytosis

    • Elevated alkaline phosphatase

    • Elevated transaminases

    • Hypoalbuminemia rare for amebic abscess

    Entamoeba histolytica serologic studies (positive in 95% of cases) in amebic abscess

    • Hydatid serologic studies (positive in > 80% of cases)

    • Schistosomal ova in feces

    • Eosinophilia in hydatid disease

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Imaging Findings

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  • CT scan and US for amebic abscess: Unifocal or multifocal fluid filled areas in liver with peripheral contrast enhancement (not distinguishable from pyogenic)

    CT scan for hydatid cyst: Presence of daughter cysts within parent cyst accompanied by calcification

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  • • Pyogenic abscess

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  • • History and physical exam

    • CBC

    • Liver function tests

    • Abdomen CT with contrast

    E histolytica serologic studies (positive in 95% of cases) in amebic abscess

    • CT-guided aspiration

    • Hydatid serologic studies (positive in > 80% of cases)

    • Schistosomal ova in feces

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Surgery

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  • • CT-guided drainage of hydatid cysts

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Medications

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  • • Metronidazole with or without chloroquine for amebic abscess

    • Albendazole for 8 weeks for hydatid disease

    • Praziquantel for schistosomiasis

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Complications

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  • • Rupture of amebic abscess or hydatid cyst

    • Secondary bacterial infection of amebic abscess or hydatid cyst

    • Hydatid cyst spilling into open peritoneal cavity

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Prevention

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  • • Improved sanitation in areas of high risk for E histolytica infection

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References

Chen SC et al: Predictors of mortality in patients with pyogenic liver abscess. Neth J Med 2008;66:183.
Hsieh HF, et al: Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score ≥ 15. Am J Surg 2008;196:346.  [PubMed: 18718219]
Johannsen EC, Sifri CD, Madoff LC: Pyogenic liver abscesses. Infect Dis Clin North Am 2000;14:547.  [PubMed: 10987109]

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