title: Amebic liver abscesses: a new epidemiological trend in a non-endemic area?
abstract: BACKGROUND
  Amoebic liver abscess (ALA) is the most common extraintestinal complication of colonic amebiasis. In recent decades its incidence in developed European countries has significantly increased because of travel and immigration of individuals from highly endemic areas. We report our 29-year experience in echo-guided percutaneous needle/catheter drainage (EPND/EPCD) of ALA.
  
  
  METHODS
  From May 1979 to November 2007, 68 ALA corresponding to 56 patients were diagnosed at our Department. All patients were treated with a metronidazole plus EPND/EPCD approach.
  
  
  RESULTS
  The majority of the cases did not need more than two echo-guided punctures. Two patients, both male immigrants (HIV-negative), had unmodified lesions after two EPNDs: catheter drainage was performed. A quick worsening of their clinical conditions and onset of neurological symptoms occurred; in both patients, computed tomography (CT) revealed a brain abscess. Intravenous medical therapy was started, but both died 4 and 3 days, respectively, after the onset of neurological symptoms (overall mortality rate: 3.57%).
  
  
  CONCLUSIONS
  The unfavorable outcome of two cases is a rare example of failure of percutaneous therapy of ALA. Mortality is a possible event even in a non-endemic area such as Italy. More observational data are needed to confirm the possibility of a new epidemiological trend.
authors.affiliation: U.O. di Escografia Interventistica IX Divisione, Naples, Italy. assanui1@virgilio.it
authors.forename: A
authors.initials: A
authors.lastname: Giorgio
authors.forename: V
authors.initials: V
authors.lastname: Esposito
authors.forename: N
authors.initials: N
authors.lastname: Farella
authors.forename: A
authors.initials: A
authors.lastname: Di Sarno
authors.forename: G
authors.initials: G
authors.lastname: Liorre
authors.forename: M
authors.initials: M
authors.lastname: DE Stefano
authors.forename: V
authors.initials: V
authors.lastname: Giorgio
authors.forename: G
authors.initials: G
authors.lastname: DE Stefano
mesh_terms: D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000469:parasitology; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008101:Liver Abscess, Amebic / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014171:Transients and Migrants; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D000981:Antiprotozoal Agents; D008795:Metronidazole