Clinical and Pathological Comparison of Pyogenic and Amoebic Liver Abscesses


BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liver abscesses were divided into two groups: the pyogenic (n = 47) and amoebic group (n = 21), which were analyzed for differences in clinical and laboratory findings. RESULTS: Amoebic liver abscesses presented most frequently in young adults (14 - 30 years; 71%), whereas pyogenic liver abscesses were most commonly observed in adults 41 - 50 years (49%). Indirect hemagglutination test revealed a 100% positive response in the amoebic group, whereas 68% of the pyogenic group presented with blood/pus culture. Multiple abscesses were observed in 66% and 24% of patients in the pyogenic and amoebic group, respectively. CONCLUSIONS: Pyogenic abscesses were commonly observed in older patients, and were associated with features such as markedly deranged liver function test, higher prothrombin time, and multiple abscesses, compared to amoebic abscess. Early and improved diagnoses and differentiation between the two conditions, followed by the correct treatment, can help prevent serious complications and lead to an overall improved mortality rate.

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Bhatti, A. , Ali, F. , Satti, S. and Satti, T. (2014) Clinical and Pathological Comparison of Pyogenic and Amoebic Liver Abscesses. Advances in Infectious Diseases, 4, 117-123. doi: 10.4236/aid.2014.43018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ochsner, A., DeBakey, M. and Murray, S. (1938) Pyogenic Abscess of the Liver: II. An Analysis of Forty-Seven Cases with Review of the Literature. The American Journal of Surgery, 40, 292-319.
[2] Blessmann, J., Ali, I.K., Ton Nu, P.A., Dihn, B.T., et al. (2003) Longitudinal Study of Intestinal Entamoeba histolytica Infections in Asymptomatic Adult Carriers. Journal of Clinical Microbiology, 41, 4745-4750.
[3] Stanley Jr., S.L. (2003) Amoebiasis. The Lancet, 361, 1025-1034.
[4] Haque, R., Duggal, P., Ali, I.M., Hossain, M.B., et al. (2002) Innate and Acquired Resistance to Amebiasis in Bangladeshi Children. The Journal of Infectious Diseases, 186, 547-552.
[5] Ralston, K.S. and Petri Jr., W.A. (2011) Tissue Destruction and Invasion by Entamoeba histolytica. Trends in Parasitology, 27, 254-263.
[6] Branum, G.D., Tyson, G.S., Branum, M.A. and Meyers, W.C. (1990) Hepatic Abscess. Changes in Etiology, Diagnosis, and Management. Annals of Surgery, 212, 655-662.
[7] Blazquez, S., Rigothier, M.C., Huerre, M. and Guillen, N. (2007) Initiation of Inflammation and Cell Death during liver Abscess Formation by Entamoeba histolytica Depends on Activity of the Galactose/N-acetyl-D-galactosamine Lectin. International Journal for Parasitology, 37, 425-433.
[8] Gyorffy, E.J., Frey, C.F., Silva Jr., J. and McGahan, J. (1987) Pyogenic Liver Abscess. Diagnostic and Therapeutic Strategies. Annals of Surgery, 206, 699-705.
[9] Hoffner, R.J., Kilaghbian, T., Esekogwu, V.I. and Henderson, S.O. (1999) Common Presentations of Amebic Liver Abscess. Annals of Emergency Medicine, 34, 351-355.
[10] Hughes, M.A. and Petri Jr., W.A. (2000) Amebic Liver Abscess. Infectious Disease Clinics of North America, 14, 565-582.
[11] Chen, S.C., Huang, C.C., Tsai, S.J., Yen, C.H., et al. (2009) Severity of Disease as Main Predictor for Mortality in Patients with Pyogenic Liver Abscess. The American Journal of Surgery, 198, 164-172.
[12] Othman, N., Mohamed, Z., Yahya, M.M., Leow, V.M., et al. (2013) Entamoeba histolytica Antigenic Protein Detected in Pus Aspirates from Patients with Amoebic Liver Abscess. Experimental Parasitology, 134, 504-510.
[13] Barnes, P.F., De Cock, K.M., Reynolds, T.N. and Ralls, P.W. (1987) Comparison of Amoebic and Pyogenic Abscess of the Liver. Medicine, 66, 472-483.
[14] Greenstein, A.J., Barth, J., Dicker, A., Bottone, E.J., et al. (1985) Amoebic Liver Abscess: A Study of 11 Cases Compared with a Series of 38 Patients with Pyogenic Liver Abscess. Am J Gasteroenterol, 80, 472-478.
[15] Kurland, J.E. and Brann, O. (2004) Pyogenic and amoebic liver abscess. Current Gasteroenterology Reports, 6, 273-279.
[16] Conter, R.L., Pitt, H.A., Tompkins, R.K. and Longmire Jr., W.P. (1986) Differentiation of Pyogenic from Amebic Hepatic Abscesses. Surgery, Gynecology & Obstetrics, 162, 114-120.
[17] Donovan, A.J., Yellin, A.E. and Ralls, P.W. (1991) Hepatic Abscess. World Journal of Surgery, 15, 162-169.
[18] Chung, Y.F., Tan, Y.M., Lui, H.F., Tay, K.H., et al. (2007) Management of Pyogenic Liver Abscesses—Percutaneous or Open Drainage. Singapore Medical Journal, 48, 1158-1165.
[19] Hope, W.W., Vrochides, D.V., Newcomb, W.L., Mayo-Smith, W.W., et al. (2008) Optimal Treatment of Hepatic Abscess. The American Surgeon, 74, 178-182.
[20] Giorgio, A., de Stefano, G., Di Sarno, A., Liorre, G., et al. (2006) Percutaneous Needle Aspiration of Multiple Pyogenic Abscesses of the Liver: 13-Year Single-Center Experience. American Journal of Roentgenology, 187, 1585-1590.
[21] Men, S., Akhan, O. and Koroglu, M. (2002) Percutaneous Drainage of Abdominal Abcess. European Journal of Radiology, 43, 204-218.
[22] O’Farrell, N., Collins, C.G. and McEntee, G.P. (2010) Pyogenic Liver Abscesses: Diminished Role for Operative Treatment. The Surgeon, 8, 192-196.

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