It appears to me that many people might be harbouring amoebic liver abscess for days or weeks before the symptoms appear. I have formed this above impression after seeing hundreds of patients of amoebic liver abscess in whom:

1. The symptoms were only of few days duration-- often about a week's duration. These patients after being repeatedly asked, confirmed that they were absolutely normal a week earlier and were drinking and eating. Many of these patients had a large abscess and on tapping more than 500 ml pus could be obtained.
2. Most of these patients had a low serum albumin in addition to raised serum alkaline phosphotase which is invariably present. In more than 1/3 serum bilirubin was slightly elevated.

The point to be noted is that serum albumin’s half life is nearly a month. If the levels of serum albumin in these patients were low, then the disease must have been present in the liver for more than a month during which period it was silent.

Is there any importance of the above observations to the clinicians? YES.

There are many patients whose sonography of the upper abdomen is being done as a part of health checkup for other complaints like that of a kidney stone. It is also a common observation that the sonographer often reports the presence of a cyst or haemangioma in the liver which might have been present from birth and is incidentally detected and calls for no treatment. The point is that often an amoebic liver abscess can mimic a cast or haemangioma as far as sonographic appearances are concerned. Therefore it will be a good principle that the clinicians in such cases should ask for investigations of serum alkaline phosphatase and ESR.

The latter two are invariably elevated in amoebic liver abscess even when it is silent. Thereafter the blood tests of Indirect Haemaglutination test for Amoebiasis (IHA test) can be asked for to confirm the amoebic aetiology.

But only after the reports of these two blood tests are normal, should a diagnosis of a cyst or haemangioma in the liver be accepted.