Liver amebiasis

Liver amebiasis is caused by Entamoeba histolytica, which is capable of parasitizing in the lumen of the gastrointestinal tract. In some infected, amoeba penetrates the intestinal wall or is disseminated to other organs, especially the liver.

The causative agent of amebiasis exists in the following forms: cyst, luminal forms (live in the lumen of the intestine), a large vegetative form found in the feces of the patient, in the walls of ulcers of abscesses are the tissue forms. The transition of an amoeba from one form to another depends on the habitat conditions in the host organism.

A person becomes infected with the use of water and food contaminated with cysts of the parasite.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]

Pathomorphology

The pathological process with amebiasis develops as a result of the direct cytopathic action of the parasite metabolites on the body cells and activation of endogenous inflammation factors released by macrophages, lymphocytes, mast cells and intestinal epithelial cells. Vegetative forms of amoeba are aerophiles, their vital functions depend on the consumption of iron parasite (erythrophage).

Single or multiple abscesses are formed more often in the right lobe of the liver. The abscess consists of the sin zones: the central zone of necrosis containing liquid necrotic masses with an admixture of blood, usually sterile (bacterial infection joins in 2-3% of cases); middle, consisting of a stroma, and an external zone containing trophozoites of amoebas and fibrin.

Symptoms of liver amebiasis

The amebiasis of the liver is manifested by clinical symptoms on average in 10% of the infected.

Allocate an "invasive" amoebiasis of the liver, in which pathological changes develop, and "non-invasive" - "carriage" of amoebic cysts.

The most frequent clinical manifestations of "invasive" amebiasis are amoebic colitis (dysentery) and amoebic liver abscess, with amoebic colitis occurring 5 to 50 times more often.

With extra-intestinal amebiasis, the bowl is affected by the liver. Amoebic hepatitis often develops on the background of clinical manifestations of intestinal amebiasis. It is characterized by hepatomegaly and pain in the right hypochondrium. When palpation is determined by a uniform increase and dense consistency of the liver, it is moderately painful. Body temperature is more subfebrile, jaundice is rare. In peripheral blood - moderately expressed leukocytosis.

Liver amebiasis can be acute and chronic. The development of an amoebic abscess in the liver is accompanied by a fever of the wrong type, in weakened children of early age - with a subfebrile condition. Pain in the right upper quadrant of the abdomen with irradiation in the right shoulder or right clavicle is more intense with subcapsular localization of the abscess, especially in the sub-diaphragmatic region. The liver is moderately enlarged, painful on palpation. The spleen is not enlarged. Neutrophilic leukocytosis is detected up to 20-30x10 ⁹ / l with a stab-shift, often eosinophilia up to 7-15%, ESR reaches 30-40 mm / h and more. Typical hypoproteinemia (up to 50-60 g / l) with hypoalbuminemia and an increase in the content of a2- and y-globulins; activity of serum transaminases and alkaline phosphatase in the normal range. The latter can increase with multiple abscesses in the liver with cholestasis, jaundice, which is very rare in children.

In 10-20% of cases, a prolonged latent or atypical course of the abscess (for example, only fever, pseudocholecystitis, jaundice) with a possible subsequent breakthrough of it, which can lead to peritonitis and damage to the organs of the chest.

Amoebic abscesses located on the upper surface of the liver, often through the diaphragm causing reactive pleurisy, can be opened into the cavity of the pleura with the formation of empyema and / or the development of the abscess of the right lung. Abscesses on the back of the liver can break through into the retroperitoneal space. Breakthrough abscess in the abdominal cavity leads to the development of peritonitis; with the adhesion of an abscess with the abdominal wall, an abscess can break through the skin of the abdomen. Amoebic abscess of the left lobe of the liver can be complicated by a breakthrough into the pericardial cavity.

Diagnosis of liver amebiasis

Amoebic liver abscesses, single and multiple, are detected with ultrasound. In the liver, foci with reduced echogenicity are determined. Radiographically, when a abscess breaks through the liver through the diaphragm into the right lung, the immobility of the dome of the diaphragm during respiration is determined. Computed tomography with liver abscess reveals a focal decrease in the densitometric density.

Abscesses of the liver of amoeba etiology are differentiated with bacterial abscesses and deep mycoses. Of decisive importance is the detection of specific antibodies with a diagnosticum for amoebiasis (ELISA). It is important to consider that amoebic abscesses can be a primary manifestation of invasion.

The prognosis for amebiasis of the liver is favorable only with timely diagnosis and rational treatment.

[15], [16], [17], [18], [19], [20], [21]

Treatment of liver amebiasis

Treatment of amebiasis of the liver is carried out by means acting simultaneously on the luminal and tissue forms of the pathogen. These drugs include derivatives of 5-nitroimidazole: metronidazole (trichopol), tinidazole, overseas - ornidazole, as well as tetracycline, oleandomycin.

Children do not have to perform surgical interventions, limited to puncture the abscess under the supervision of ultrasound or CT with aspiration of the contents and the introduction of specific means into the cavity. Amoebae are rarely found in the center of necrotic masses and are usually localized in the outer walls of the abscess.

Controlled studies did not reveal the advantages of using metronidazole in combination with aspiration before one metronidazole.

Prevention of liver amebiasis

The most effective are decontamination and removal of feces, prevention of contamination of food and water, protection of reservoirs from fecal contamination.

Strict compliance with the rules of personal hygiene is very important.