Amoebic Liver Abscess by Dr. O.P. Kapoor

Before I answer this question, I would like to make it clear that the word "chronic" has been coined by some clinician who has never visited the post mortem room! At the autopsies supervised by me on hundreds of patients who have died of amoebiasis (by complications of colonic ulcers and liver abscess), not a single case was observed who had "chronic" intestinal disease. It was always "acute". Yes, in practice you may see "recurrence" of the disease (occurring again and again). Even this is unlikely with the introduction of modern drugs like Metronidazole or Tinidazole. Such patients are likely cases of "ulcerative colitis" if they are passing blood and mucus in the stools. If not, then they are cases of irritable colon, for which there is no permanent cure.

Patients whose stools show cysts of E. Hystolytica may be carriers only. But then how to exclude "active" amoebic disease in such patients?

Sigmoidoscopy should be done to see any ulcers in the terminal colon. If seen, a "biopsy" must be done. Only if amoebic necrosis or amoebae are seen in the biopsy report, should a diagnosis of amoebiasis be considered. (Of course it should respond dramatically to drugs!) Serological tests for amoebiasis (like I.H.A. test or C.I.E.A.) though more often positive in hepatic arnoebiasis may also be positive in cases of intestinal amoebiasis. But remember, serological tests like "Widal Test" can also be, very often misguiding (unless you are very well read about their interpretation including their "anamnestic" reaction like response). Ideally combination of 2 to 3 serological test reports, including fluorescence Antibody Test, should be more decisive in the diagnosis. This is not practical in private practice specially from cost effectiveness point of view. It would be much cheaper to try a therapeutic test with Metronidazole (proper dose for intestinal amoebiasis is 800 mg. t.d.s. for 5 days) or Tinidazole!!!

But hang on doc - these drugs are poly therapeutic drugs. They also show very good results in:

Patients of irritable colon like many other drugs or placebos
Patients of Giardiasis.
Infection with anaerobic organisms of the intestines (ideal drugs).
The infection by the organism - Campylobacter Pyloridis which is one of the known causes of "Peptic Ulcer" - a common, differential diagnosis of a colonic pain! (Remember peptic ulcer syndrome and irritable colon are often present in the same patient).

Finally how can you diagnose amoebiasis as the cause of a patient's complaint—when majority of E. Hystolytica seen in stools have been shown to be benign! Only types II, XI and XII out of 18 Zymodomes, are the ones, which can produce disease. In India, the investigations to "subtype" these amoebae are not available just now. Even then, do you think doc, that your patients will be able to pay for these costly tests in the pathological labs!! Amoebiasis is a disease of poor people. In a rich, young man or woman, passing blood and mucus in the stools, in the modern times of stress, ulcerative colitis should be the first diagnosis! (In older diabetics and hypertensives - Ischaemic Colitis).