[Amoebic Liver Abscess][Dr. O.P. Kapoor]
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WORLD DISTRIBUTION

. Amoebiasis is common in under-developed countries, more so amongst populations with low socio-economic status,1-5 living in congested localities2 with poor sanitation.2,6,7
The world distribution of amoebic liver abscess should parallel that of amoebic infection. Unfortunately, after sifting the literature, one gets thoroughly confused regarding the actual incidence of amoebic liver abscess. Some of the difficulties encountered are as follows : -
Amoebiasis being more common in the developing countries, often there are no teaching institutions or academically interested personnel with necessary equipment to confirm the diagnosis in these areas. Thus, a lot of clinical material on amoebic liver abscess from these regions goes unreported.
As the amoebic liver abscess is a confirmed entity and is quite common in places where amoebiasis occurs, clinicians from these areas report cases with ‘rare’ features only.
In the old literature diagnostic criteria of amoebic liver abscess are very often not clearly defined.
Publications which highlight the value of a diagnostic aid or a therapeutic regime, do not always mention the total number of patients seen in a relation to the bed strength of the hospital, total population of the place or the period over which these patients have been observed.
Reports based on post-mortem studies give the numerical details. Unfortunately the number of patients reaching the post-mortem room constitutes only a small percentage of the total.
Drawing conclusions from the literature is further made difficult because not all publications distinguish clearly between amoebic abscess and amoebic hepatitis.
In the developed countries the incidence of amoebiasis and hence even amoebic liver abscess has gone down tremendously. In this chapter therefore only those reports which have appeared in the last four decades will be considered.
Amoebic liver abscess and colitis have become almost non-existent in Alaska and Canada.4,8 In Canada, amoebic infection is encountered only in small patches of Indian population among whom it is endemic.9
In the United States, the incidence of amoebic infection has decreased considerably. Except for Massachusetts there are no reports of amoebic liver abscess from the northern states.10 Kean et al11 and Radke12 have both presented material from Armed Forces Institutes. These studies cannot be taken as true representatives of the general American population because it is very common for Armed Forces personnel to visit countries where amoebiasis is endemic. Amoebiasis itself5,12 and amoebic liver abscess are still prevalent in states of Louisiana,13-15 Texas16-18 and Arkansas,19 but their incidence is now falling. Reynold20 feels that the incidence of amoebic liver abscess is increasing in California. Upto 1965 he used to treat an average of 5 to 6 patients per year. The number slowly increased from 1966 to 1968 and in 1969 as many as 23 patients of amoebic liver abscess were treated by him.
In Mexico the incidence is still high,21,22 although Elsdon-Diw4 could collect only 28 cases of amoebic liver abscess in a single year (1958).
Amoebiasis is common in Guatemala, Costa Rica and Panama23 but reports on amoebic liver abscess are very few.24,25 Gorga Hospital (Panama) had only 50 cases in 25 years.4 There are occasional case reports from Cuba.26
Da Silva and Torres have reported low incidence of amoebiasis in Brazil.27
Intestinal amoebiasis is still common in Colombia3 but reports on amoebic liver abscess are rare.28
The problem of amoebic liver abscess is non-existent in the European countries. Wright29 cites the difficulty encountered in diagnosing amoebic liver abscess in the United Kingdom. The disease is so rare that it skips the mind.
From the African countries (except South Africa), there are hardly any reports on amoebic liver abscess. South African scientists have made up for the rest of Africa. Most of the pioneer workers in the field of amoebiasis in the last five decades have been from this country. Intestinal infection with amoebae is not rare in Egypt30_32 but the reports on amoebic liver abscess are not many.33
Asia harbours many countries of the third world and it is not surprising that amoebiasis and even in this continent, specially in the South-East Asian countries. There are no reports of amoebic liver abscess from Japan, Iran, Afghanistan. Maximum case reports are from India.
Most of the pioneering work of establishing amoebic liver abscess as a distinct clinical entity was done by British workers in West Bengal.34-37. However, in recent years there have been few reports from that region. More publications are from Bombay. A look at the table given below will how that the incidence of amoebic liver abscess is increasing in the city of Bombay. Punjab in North and Tamil Nadu in South are other regions of India where publications on amoebic liver abscess have appeared.
The other South-East Asian countries where amoebiasis seems to be common are Malaysia, 38 Korea39,40 and Taiwan.41
A glance at the following table (Table 1) gives a rough idea regarding the incidence of amoebic liver abscess in various parts of the world. The reports of post-1940 era with more than one case showing definite diagnostic criteria have been included here.
From the above table, the only conclusion we can draw is that the amoebic liver abscess is common in South-East Asia and South Africa.

TABLE 1

World distribution of Amoebic Liver Abscess

Countries

Year

 Name of author No of cases No. of years Nature of studies
NORTH AMERCIA          
United States of America

1952

 Radke12 42   (AFIP autopsy study )
 

1956

 Kean11 90   (AFIP)
Massachusetts

1960

 Sherman42 3 5 (of 99 liver abscesses and 21,945 autopsies)
 

1974

 De la Maza10 0   (Of 9,489 autopsies)
Louisiana

1951

 DeBakery & Ochsner13 263 20  
 

1966

 Turrill114 26 17  
 

1973

 Ribaudo15 21 20  
 

1956

 Patterson & Lawlis16 20    
Texas

1967

 May17 15 23  
 

1968

 Cain18 17 10  
Arkansas

1971

 Juniper19 149 22 (Cases of invasive amoebiasis)
California

1969

 Grant43 9 1  
 

1971

 Reynold20 23   (In 1969)
Georgia

1967

 Dorrough39 23 13  
Alabama

1968

 Sheehy44 17    
N. Carolina

1946

 Smith & Ruffin45 13 16  
Mexico

1959

 Sepulveda21 74    
 

1959

 FloresBarroeta22 98   (of 2202 autopsies)
 

1964

 Elsdon-Dew4 28   (Of 3354 admissions, 1958)
Costa Rica

1958

 Cespedes24 13   (In 3320 autopsies)
Panama

1950

 Struve25 50 25  
Cuba

1949

 Val Raalte26 2    
Puerto-Rico

1947

 Santiago-Stevenson46 2 3  
SOUTH AMERICA          
Cayenne

1951

 Castile47 6 5  
Colombia

1956

 Cortez-Mendoza28 47   (Of 728 cases)
Chile

1949

 Pizzi & Cespedes48 20   (5,000 autopsies)
 

1964

 Boero & Shurmann49 39   (7,110 autopsies)
EUROPE          
United Kingdom

1961

 Paulley50 17 7  
 

1966

 Wright29 6   (With pleuropulmonary complications)
Italy

1952

 Scaffidi51 10    
AFRICA          
South Africa

1958

 Wilmot52 35   (Drug trial)
 

1958

 Lamont & Pooler53 250    
 

1961

 Scragg54 100    
 

1962

 Keeley55 10   (Biopsy for amoebic liver abscess)
 

1965

 Powell56 360   (For serology)
 

1968

 Maddison57 42    
Egypt

1976

 Ragheb33 10   (Only intrathoracic complications)
Nigeria

1965

 Adi58 76   (Of 90 aspirates)
 

1965

 Essien59 20   (Of 921 autopsies)
 

1965

 Olatunbosun60 4 7 mths. (Of 14 liver abscesses)
Tunisia

1956

 Corcos61 15    
Morocco   Perald & Rouz Berger62      
Sierra Leone

1963

 Rowland63 17   (Radiological study)
Kenya

1968

 Elsdon-Dew4 7   (In 450 bed hospital, 1958)
Rhodesia

1966

 Gelfand64      
ASIA          
Israel

1951

 Schoor & Schwartz65 99   (Radiological study)
 

1961

 Alkan66 8   (Only left sided abscess - clinical)
Saudi Arabia

1958

 Elsdon-Dew4 1   (317 bed hospital)
Lebanon

1973

 Uthman67 37 7  
Sri Lanka

1947

 Parkinson68 2   (In 635 admissions)
 

1960

 Paul69 203 23  
 

1974

 Ramachandran70 80 31/2  
 

1974

 Rasaretnam71 31 16 (Thoracic unit)
India          
Bombay (Maharashtra)

1955

 Purandare72 105 27 (12,686 autopsies)
 

1969

 Aptekar73 50 4  
 

1970

 Mehta74 158 4  
 

1972

 Joshi & Kapoor75 268 5  
 

1973

 Nadkarni76 72    
Goa

1968

 Aikat77 15   (665 autopsies)
Chandigarh

1973

 Datta78 95 5  
Patiala (Punjab)

1966

 Malhotra79 14 1  
Vishakapatnam (Andhra Pradesh)

1962

 Reddy80 32 33 (In 2995 autopsies)
Madras (Tamil Nadu)

1970

 Subramaniam81 103 5  
Bangladesh

1960

 Islam82 50    
Malaysia

1950

 Da Silva38 13   (Of 57 hepatic abscesses)
 

1956

 Andre83 409 7  
Indonesia

1956

 Schaible84 73 8  
Philippines

1963

 Villano85 73 8  
Taiwan

1973

 Tsai Shen Ho41 2322 18  
Korea

1964

 Elsdon-Dew4 1   (3824 patients in 1958)
 

1967

 Dorrough39 22   (In 5619 admissions)
 

1972

 Crane40 200    

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