Korean J Gastroenterol.  2020 Jul;76(1):28-36. 10.4166/kjg.2020.76.1.28.

Current Status of Amebic Liver Abscess in Korea Comparing with Pyogenic Liver Abscess

• Kim E
• Park DH
• Kim KJ
• Kim TO
• Park SH
• Park J
• Choi JH
• Lee J
• Park YE
• Oh EH
• Hwang JS
• Heo NY

• KMID: 2504567
• DOI: http://doi.org/10.4166/kjg.2020.76.1.28

Abstract

Background/Aims
With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess.
Methods
Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period.
Results
Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%.
Conclusions
Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.

Keyword

Liver abscess; amebic; Entamoeba histolytica; Republic of Korea

Figure

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  Fig. 1 Patients’ enrollment.

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  Fig. 2 Computed tomographic findings of liver abscess. (A) Internal septation. (B) Peripheral rim enhancement (arrow). (C) Double target sign (arrowheads). (D) Hyperemia in adjacent hepatic parenchyma (arrow). (E) Cluster sign. (F) Gas formation; the image from (A-D) originated from the patients with amebic liver abscess, and the other (E, F) were from patients with a pyogenic liver abscess.

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  Fig. 3 Index case of amebic liver abscess in a patient from Cambodia. Abdominal CT showed a 13×10 cm-sized lobulating contoured, ill-defined peripherally enhancing lesion in the right hepatic lobe (A). The drained fluid from the liver abscess looked chocolate color (B).

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