Background: The abscess of liver is a life threatening disease with majority being amoebic liver abscess in tropical countries like India. The abscesses of liver can be broadly divided into two categories: amoebic and pyogenic. Amoebic liver abscesses (ALA) are the most common extraintestinal site of infection, and occur in fewer than 1% of E histolytica infections ^[1,2].Treatment modalities grossly changes between abscesses of liver due to amoebic and pyogenic origin and hence the need to differentiate between them early arises. Indirect Haemagglutination test has been an important diagnostic tool in differentiating between liver abscesses of liver due to pyogenic and amoebic origin. Etiopathogenesis of liver abscess due to amoebic origin is different from that of  liver abscess due to pyogenic origin (PLA). Confirmatory diagnosis is indeed important in resource limited settings, as it leads to appropriate management.

Aim and Objectives:

1. The main aim is to distinguish between liver abscess due to amoebic and pyogenic origin using Indirect Haemagglutination test.
2. To identify the contrast between clinical presentation of Amoebic and Pyogenic liver abscess with its complications. 

Materials and Methods: A prospective study done during 2018 to 2020 in patients with Clinical/Radiological features of Liver Abscess presenting to RMMCH, Chidambaram with a sample size of 50. Serum obtained from all study subjects and sent for Indirect Haemagglutination test. Pus collected from the abscess cavity sent for culture and sensitivity and their results studied.

Results: From 50 samples studied 33 were diagnosed to have amoebic liver abscess by positive Indirect Haemagglutination  with sterile culture report, 10 patients were diagnosed to have pyogenic liver abscess by isolating organism from pus aspirated from abscess cavity and 7 patients with sterile culture and negative indirect haemagglutination  as indeterminate.

Conclusion: Indirect haemagglutination test of Entamoeba histolytica gives an accurate diagnosis of liver abscess due to amoebic origin. The clinical features and indirect hemagglutination test results helps in achieving accurate diagnosis of amoebic liver abscess.Rapid diagnosis with serology using indirect haemagglutination and initiation of prompt treatment can reduce the hospital stay in the management of amoebic liver abscess

Keywords: Indirect haemaggutination test, liver abscess of amoebic and pyogenic origin.

1. Haque R, Huston C, Hughes M, Houpt E, Petri W. Amebiasis. N Eng J Med. 2003; 348:1565–73. [PubMed] [Google Scholar]
2. Knobloch J, Manweiler E. Development and persistence of antibodies to Entamoeba histolytica in patients with amebic liver abscess: Analysis of 216 cases. Am J Trop Med Hyg. 1983; 32:727–32. [PubMed] [Google Scholar]
3. Cosme A, Ojeda E, Zamarreño I, Bujanda L, Garmendia G, Echeverría MJ, et al. Pyogenic versus amoebic liver abscess. A comparative clinical study in a series of 58 patients. Rev Esp Enferm Dig 2010;102:90-9. Back to cited text no. 3
4. Sifri CP, Madoff LC. Infections of the liver and biliary system. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett′s Principles and Practice of Infectious Diseases.7 th ed. Edinburg: Churchill Livingstone; 2010. p. 1035-44.
5. Kale S, Nanavati AJ, Borle N, Nagral S. Outcomes of a conservative approach to management in amoebic liver abscess. J Postgrad Med. 2017 Jan-Mar; 63(1):16-20. [PMC free article] [PubMed]
6. Akgün Y, Taçyιlιdιz Ï H, Çelik Y. Amebic liver abscess. Changing trends over 20 years. World J Surg. (1999);23:102–106. [PubMed]
7. Donovon A J, Yellin A E, Ralls P W. Hepatic abscess. World J Surg. (1991);15:162–169. [PubMed]
8. Pitt H A. Surgical management of hepatic abscesses. World J Surg. (1990);14:498–504. [PubMed]
9. Saidin S, Yunus MH, Zakaria ND, Razak KA, Lim BH, Othman N, et al. Production of recombinant E. histolytica pyruvate phosphate dikinase and its application in a lateral flow dipstick test for amoebic liver abscess. BMC Infectious disease. 2014;14:182. [PMC free article] [PubMed] [Google Scholar]
10. Bansal D, Sehgal R, Chawla Y, Malla N, Mahajan RC. Multidrug resistance in amoebiasis patients. Indian J Med Res. 2006;124:189–94. [PubMed] [Google Scholar]
11. Healy GR, Cahill KM, et al. The serology of amoebiasis. Bull NY Acad Med. 1970;47:494–507. [Google Scholar]
12. Knobloch, Mannwcilcr E. Development and persistence of antibodies at E. histolytica in patients with Amebic liver abscess. Am J Trop Mod Hyg. 1983;32:727–32. [PubMed] [Google Scholar]
13. Arianpour N, Mohapatra TM. Study of Antiamoebic Antibody in Amoebiasis Using ELISA and RID Techniques. Iranian J Publ Health. 2003;32:13–18. [Google Scholar]
14. Doorn RH, Hofwegen H, Koelewijn R, Gilis H, Rose R, Jose CFM, et al. Use of Rapid Dipstick and Latex Agglutination Tests and Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Amebic Liver Abscess, Amebic Colitis, and E. histolytica Cyst Passage. Journal of Clinical Microbiology. 2005;43:4801–06. [PMC free article] [PubMed] [Google Scholar]
15. Anjana S, Houpt E, Petri WA. Rapid Diagnosis of Intestinal Parasitic Protozoa, with a Focus on E. histolytica. Interdisciplinary Perspectives on Infectious Diseases. 2009:1–8. [PMC free article] [PubMed] [Google Scholar]
16. Maltz G, Knauer CM. Amebic liver abscess: A 15 year experience. Am J Gastroenterol. 1991; 86:704. [PubMed] [Google Scholar]
17. Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA. Features distinguishing amoebic from pyogenic liver abscess: A review of 577 adult cases. Trop Med Int Health. 2004; 9:718–23. [PubMed] [Google Scholar]

Dr Anvar Ali A

Professor, Dept of General Surgery, Rajah Muthiah Medical College and Hospital, Annamalai Nagar, Chidambaram, India, 608002