Factors associated with high rates of recurrence of amebic liver abscess (ALA) in north India

Recurrence of amebic liver abscess (ALA), once considered unusual, is increasingly being reported, despite proper management. Realizing the endemicity of ALA in the study setup, this 2-year follow-up study was conducted to investigate the recurrent cases and study the associated factors. A total of 101 confirmed cases of ALA were followed up for a period of 2 years. Recurrent cases were studied for associated bacterial flora, presence of resistance genes (nim), level of matrix metalloproteinase 3 and MMP-9, and genotypes of Entamoeba histolytica and statistically compared with the nonrecurrent cases as controls. Recurrence rates of 8.9% (nine patients) were detected. The presence of Prevotella along with an increased level of MMP-9 in abscess fluid and large size of abscesses (11 × 10.8 cm) was found to be significantly associated with recurrence in ALA. Among the nine cases, the presence of nimE gene was detected in two (22.2%) patients. The genotyping of E. histolytica strains showed that in seven (77.7%) cases, the genotype of E. histolytica was the same in the primary and recurrent samples. This study reports a high rate of recurrence in the cases of ALA, hinting toward the gradual development of clinical resistance toward the commonly used drug. The presence of nim gene and Prevotella in abscess fluid along with increased MMP-9 levels and large abscess size could be important predictors of recurrent ALA.