Absceso hepático amebiano en el embarazo: reporte de un caso / Amebic liver abscess in pregnancy: a case report

La asociación de absceso hepático amebiano y embarazo es poco frecuente y se asocia a un aumento de la morbilidad y mortalidad materna. Presentamos el caso de una paciente de 33 años, cursando un embarazo de 35 semanas, que ingresó a nuestro servicio con el diagnóstico de absceso hepático, cuya etiología fue E. histolytica.

The appearance of amebic liver abscess in pregnancy is uncommon and is associated to increased maternal morbidity and mortality. We report the case of 33 years old woman, with a 35 weeks pregnancy that was admitted in our Hospital with the diagnosis of liver abscess, whose etiology was E. histolytica.

Endoscopic biliary drainage in patients with amebic liver abscess and biliary communication.

BACKGROUND: Percutaneous drainage or surgery is required when amebic liver abscess (ALA) fails to respond to medical management. In some of these patients, non-response may be due to communication of ALA with the biliary tree. This report describes our experience with the use of endoscopic biliary draining in such patients. METHODS: Medical records of patients with ALA undergoing either needle aspiration or percutaneous pigtail drainage were retrieved; the indications for drainage were: abscess volume exceeding 250 mL, a thin rim of tissue (< 1 cm thick) around the abscess, systemic toxic features and failure to improve on medical treatment. Patients with abscess drain output >25 mL/day persisting for 2 weeks or presence of bile in the drain fluid underwent endoscopic biliary drainage. RESULTS: A total of 115 patients with ALA underwent percutaneous treatment. None of the 25 patients with needle aspiration needed any further treatment. Of the 90 who underwent catheter drainage, the catheter could be removed within one week in 77 patients; the remaining 13 patients (median age 42 years, range 24-65; all men) had an abscess-biliary communication. In them, the median catheter output was 88 mL/day (range 45-347) and 54 mL/day (28-177) at 2 days and 2 weeks after catheter placement. The drain fluid contained bile in all 13 patients and in addition contained pus in 10 patients. Eleven patients had a solitary abscess and two had multiple abscesses. Cholangiogram showed biliary communication in all 13 patients. All patients were treated with placement of 10F biliary endoprosthesis or 10F nasobiliary drain. Pigtail catheter was removed within 1 week in 11 of 13 patients. CONCLUSION: In patients with amebic liver abscess communicating with the biliary tree, biliary stenting may hasten clinical recovery and allow early removal of liver abscess catheter drain.

Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess.

BACKGROUND AND OBJECTIVE: Direct demonstration of Entamoeba histolytica by conventional microscopy and in vitro culture in pus obtained from amebic liver abscess (ALA) is often unsuccessful. We evaluated polymerase chain reaction (PCR) for detection of E. histolytica DNA in such pus. METHODS: Species-specific primers were used for the amplification of E. histolytica DNA from liver pus obtained from 30 patients with ALA. Patients with pyogenic liver abscess and sterile (autoclaved) pus spiked with Entamoeba dispar and bacteria (Escherichia coli, Klebsiella spp. and Bacteroides spp.) were used as negative controls. RESULTS: PCR was positive in 83% of pus specimens from patients with ALA, and was negative in all 25 pus specimens obtained from pyogenic abscess and autoclaved pus spiked with known bacteria. Sensitivity and specificity of PCR were 83% and 100%, respectively. The overall positivity of PCR was higher compared to serological tests. CONCLUSION: PCR may be a more reliable and better alternative diagnostic modality for ALA.

Correlación Clínico-Inmunológica en Absceso Hepático Amebiano / Clinico-Immunological Correlation in Amebic Liver Abscess

INTRODUCCION: El curso de un Absceso Hepático Amebiano (AHA) con tratamiento adecuado presenta una etapa aguda con niveles altos de IgG, IgM, IgA, IgE y respuesta de hipersensibilidad retardada específica negativa, y una etapa de recuperación IgM, IgE e IgA no detectables y respuesta de hipersensibilidad retardada positiva; la IgG continúa positiva por largos períodos de tiempo. Existen muchas evidencias de que la protección en AHA es mediada por la respuesta inmune celular. En la etapa aguda predomina una respuesta humoral probablemente no protectora y en la fase de recuperación una respuesta celular protectora. En este estudio se pruebe la hipótesis de que la severidad del absceso es directamente proporcional al grado de respuesta inmune humoral. MATERIALES Y METODOS: Se estudiaron 10 pacientes con diagnóstico clínico, ecográfico y serológico compatible con AHA, tratados con metronidazol 750 mg/día vía oral por 15 días. Se determinió el tamaño del absceso, velocidad de sedimentación globular, niveles de bilirrubina, transaminasas, fosfatasa alcalina e IgG. Luego se realizaron análisis de regresión lineal relacionando los niveles de IgG con los indicadores clásicos de severidad en AHA (tamaño del absceso, niveles de transaminasas y bilirrubina). RESULTADOS: Los niveles de IgG estuvieron significativamente asociados con: Tamaño del absceso (P=0.0248), ALT (P=0.033) y bilirrubina indirecta (P=0.05); se observó una tendencia de correlación, aunque sin significancia estadística, con la AST (P=0.1529). El tamaño del absceso se correlacionó directamente con el tiempo de evolución (P=0.018); la AST (R=0.595, P=0.210) y ALT (R=0.761, P=0.135) se correlacionaron inversamente. Las diferencias entre los pacientes crónicos y agudos no fueron estadísticamente significativas para la ALT (P=0.0710) y AST (P=0.213). CONCLUSION: La respuesta humoral parece no tener efecto protector en AHA y los niveles de anticuerpos pudieran ser un buen indicador de severidad