Amoebic Liver Abscess

An amoebic liver abscess is a collection of pus in the liver caused by the parasite Entamoeba histolytica, which can spread from the intestine to the liver. It is a serious complication of amoebiasis, requiring prompt diagnosis and treatment.

• Fever, often with chills
• Pain in the right upper abdomen, which may worsen with movement or deep breathing and can radiate to the right shoulder
• Tenderness over the liver area on examination
• Loss of appetite and weight loss
• A history of preceding or concurrent diarrhoea is common, though not always present

• Caused by the parasite Entamoeba histolytica, the same organism responsible for intestinal amoebiasis, which can spread from the intestine to the liver via the bloodstream.
• Risk is increased by prior or concurrent intestinal amoebic infection, though a liver abscess can occasionally occur without a clearly recognised preceding intestinal illness.
• More common in men and in adults than children.

• Suspected based on the characteristic fever and right upper abdominal pain, particularly in someone from or with a history of travel to an area where amoebiasis is common.
• Abdominal ultrasound is the key test, showing a characteristic fluid-filled collection within the liver.
• Blood tests often show markers of infection and inflammation, and stool testing for the parasite may be positive, though a negative stool test does not rule out the diagnosis.

Treatment with an antiamoebic antibiotic, such as metronidazole, for 7–10 days is highly effective and resolves the majority of cases without the need for drainage.

This is typically followed by a luminal-acting antiamoebic medicine to clear any remaining intestinal cysts and prevent relapse or ongoing transmission.

Larger abscesses, those not responding to medicine within a few days, or those at risk of rupture may require drainage, usually guided by ultrasound, at a facility with the necessary capability.

Close monitoring is important, as a ruptured abscess (into the abdominal cavity, chest, or elsewhere) is a serious complication requiring urgent additional treatment.

• Drink water from safe sources, or boil or treat water before drinking.
• Wash hands with soap after using the toilet and before preparing or eating food.
• Seek prompt treatment for intestinal amoebiasis to reduce the risk of the infection spreading to the liver.
• Seek medical assessment promptly for fever with right upper abdominal pain, particularly with a relevant history of possible amoebic exposure.