This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

1. Amoebiasis
Dr. Ashok Jaisingani

2. Introduction
► Amoebiasis is caused by Entamoeba histolytica
► The majority of infected individuals are remain
asymptomatic carriers.
► The mode is via faeco – oral route.
► Disease occurs as a result of substandard hygiene and
sanitation.
► Amoebic liver abscess is the commonest extraintestinal
manifestation, occurs in less than 10%. In endemic areas it
is much more common than pyogenic abscess.
► Pts who are immunocompromised or alcoholic are more
susceptible to infection.

3. Pathogenesis
► The organisms enter the gut through food and water
contaminated with cyst.
► In small bowl hatching of cyst result into large number of
trophozytes which reached to colon where “Flask Shaped
Ulcer” form in the submucosa.
► The trophozytes multiply, ultimately forming cyst which
enter the portal circulation reach to liver, where they
multiply in portal triad causing focal infarction of
hepatocytes and liquificative necrosis (liver abscess), and
also passed in the faces as an infective form that infect
other humane being as result of unsanitary conditions.

4. Amoebic Liver Abscess
► The right lobe is involved in 80% of the cases, the
left in 10% and rest are multiple.
► The abscess are most common high in
diaphragmatic surface of right lobe, this may
cause pulmonary symptoms and chest
complication.
► The abscess cavity contain chocolate colored,
odorless, anchovy sauce – like fluid that is mixture
of the necrotic liver tissue and blood.
► Untreated abscess are likely to be rupture. While
pus in abscess is sterile unless secondarily infected

5. Chronic Amoebic Infection Of Large
Bowl
► ChronicInfection of large bowl may result
into granulomatous lesion along the large
bowl, most commonly seen in caecum called
as “Amoeboma”

6. Clinical Features
► Typical pts with amoebic liver disease is young adult male
with history of “Pain and fever” with insidious onset of non
– specific symptoms
- Anorexia
- Night Sweats
- Malaise
- Cough
► Then gradually more specific symptoms such as
1- Pain in right upper abdomen, shoulder tip pain
2- Hicoughs
3- Non – productive cough
► There may also be past history of bloody diarrhea or travel
to endemic areas raise the suspicious index.

7. Clinical Examination
► Examination reveals pt who is toxic and anemic
► Pt will have upper abdominal rigidity
► Hepatomegaly
► Tender & bulging intercostal space
► Overlying skin edema
► Pleural Effusion
► Basal pneumonitis (usually late manifestation)
► There may be jaundice or ascites also present
► Rarely there may be rupture of abscess cavity into
peritoneum, pleural space or pericardial cavity and pts
present as an emergency.

8. How To Differentiate Amoeboma
From Right Sided Colon Cancer?
► An amoeboma should be suspected when a
patient from endemic area with generalized
ill health and pyrexia have a mass in right
iliac fossae, with history of blood stained
mucoid diarrhea.
► Such type of pts is highly unlikely to have
carcinoma as “altered bowl habit” is not
feature of right sided colon cancer.

9. Investigation
► Haematological Tests
► Biochemical Tests
► Serological Tests (more specific to detect antibodies) are
1- Test for compliment fixation
2- Indirect haemagglutination assay (IHA)
3- Indirect Immunoflourescence
4- Enzyme – like Immunosorbent assay (ELISA)
► IHA has very high sensitivity rate in acute amoebic liver
abscess in non – endemic region and remain elevated for
some time.
► An outpatient rigid sigmoidoscopy using disposable
instrument is very useful particularly if pts complain bloody
mucoid diarrhea.

10. Haemetological & Biochemical Tests
► These investigation reflects the presence of
chronic infective process with
1- Anemia
2- Leucocytosis
3- Elevated ESR
4- Elevated C – reactive protein
5- Hypoalbunaemia
6- Deranged Liver Function Test
7- Elevated alkaline phosphate

11. Sigmoidoscopy
► Sigmoidoscopy show shallow skip lesion and
flask shaped or “collar – stud” undermine
ulcer may be seen and can be biopsied or
scraping can be taken along with mucus for
microscopic examination.
► Presence of trophozoites distinguish the
condition from ulcerative collitis.

12. Imaging Technique
► Ultrasound and CT – scan are the imaging
method of the choice.
► Ultrasound investigation is very accurate
and is used for aspiration, both diagnostic
and therapeutic purpose.
► Doubtful cases CT – scan confirm the
diagnosis.

13. Amoebic Treatment
► Medical treatment is very effective should be first choice.
► Metronidazole and tinidazole are effective drugs
► Diloxanide furoate, not effective against hepatic infestation is used for
10 days to destroy intestinal amoeba
► In large abscess repeated aspiration is combined with drug treatment,
threshold for aspiring abscess in left lobe is lower because its
predilection for rupturing into pericardium.
► Surgical treatment reserve for the complication such as rupture into
pleural, peritoneal or pericardial cavity.
► Resuscitation, Drainage and appropriate lavage with vigorous medical
treatment are key principles.
► Acute toxic megacolon and hemorrhage are intestinal complication that
are treated with intensive supportive therapy followed by resection and
exteriorisation.
► When an amoeboma is suspected in a colonic mass cancer should be
excluded by appropriate imaging.