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World J Clin Cases. Dec 26, 2022; 10(36): 13157-13166
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13157
Amebic liver abscess by Entamoeba histolytica
Daisuke Usuda, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Hayabusa Takano, Shintaro Shimozawa, Yuta Hotchi, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Takayuki Komatsu, Jiro Oba, Tomohisa Nomura, Manabu Sugita
Daisuke Usuda, Shiho Tsuge, Riki Sakurai, Kenji Kawai, Shun Matsubara, Risa Tanaka, Makoto Suzuki, Hayabusa Takano, Shintaro Shimozawa, Yuta Hotchi, Shungo Tokunaga, Ippei Osugi, Risa Katou, Sakurako Ito, Kentaro Mishima, Akihiko Kondo, Keiko Mizuno, Hiroki Takami, Takayuki Komatsu, Jiro Oba, Tomohisa Nomura, Manabu Sugita, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
Takayuki Komatsu, Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
Author contributions: Usuda D wrote the manuscript; Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Takano H, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, and Sugita M proofread and revised the manuscript; All authors approved the final version to be published.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daisuke Usuda, MD, MSc, PhD, Associate Professor, Doctor, Senior Lecturer, Staff Physician, Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima 177-8521, Tokyo, Japan. d.usuda.qa@juntendo.ac.jp
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: October 17, 2022
Revised: November 1, 2022
Accepted: December 8, 2022
Article in press: December 8, 2022
Published online: December 26, 2022
Abstract

Amebic liver abscesses (ALAs) are the most commonly encountered extraintestinal manifestation of human invasive amebiasis, which results from Entamoeba histolytica (E. histolytica) spreading extraintestinally. Amebiasis can be complicated by liver abscess in 9% of cases, and ALAs led to almost 50000 fatalities worldwide in 2010. Although there have been fewer and fewer cases in the past several years, ALAs remain an important public health problem in endemic areas. E. histolytica causes both amebic colitis and liver abscess by breaching the host’s innate defenses and invading the intestinal mucosa. Trophozoites often enter the circulatory system, where they are filtered in the liver and produce abscesses, and develop into severe invasive diseases such as ALAs. The clinical presentation can appear to be colitis, including upper-right abdominal pain accompanied by a fever in ALA cases. Proper diagnosis requires nonspecific liver imaging as well as detecting anti-E. histolytica antibodies; however, these antibodies cannot be used to distinguish between a previous infection and an acute infection. Therefore, diagnostics primarily aim to use PCR or enzyme-linked immunosorbent assay to detect E. histolytica. ALAs can be treated medically, and percutaneous catheter drainage is only necessary in approximately 15% of cases. The indicated treatment is to administer an amebicidal drug (such as tinidazole or metronidazole) and paromomycin or other luminal cysticidal agent for clinical disease. Prognosis is good with almost universal recovery. Establishing which diagnostic methods are most efficacious will necessitate further analysis of similar clinical cases.

Keywords: Amebic liver abscess, Entamoeba histolytica, Polymerase chain reaction, Enzyme-linked immunosorbent assay, Percutaneous catheter drainage, Amebicidal drug

Core Tip: Amebic liver abscesses are the most commonly encountered extraintestinal manifestation of human invasive amebiasis, which results from Entamoeba histolytica. It breaches the host’s innate defenses and invades the intestinal mucosa. Trophozoites enter the circulatory system and are filtered in the liver and produce abscesses. The diagnostics primarily aim to use PCR or enzyme-linked immunosorbent assay to detect Entamoeba histolytica. Medical treatment of amebic liver abscesses is possible using an amebicidal drug and a luminal cysticidal agent. Prognoses are generally good. Elucidating the detailed pathogenesis and establishing which diagnostic methods are most efficacious will necessitate further analyses of similar clinical cases.