Liver abscesses most common in India -- and Covid-19 has pushed up the numbers

New Delhi, Sep 22 : If you are experiencing recurrent fever, loss of appetite, diarrhoea, coupled with a dull, throbbing sensation in the upper right abdomen (liver), you might be suffering from liver abscesses -- one of the most common gastro-intestinal conditions in India.

The Covid-19 pandemic seems to be also pushing up the number of people with liver abscess, as indicated by anecdotal evidence. As many as 21 patients who recovered from Covid-19 have now been diagnosed with "unusually large" and multiple liver abscesses in the past two months at Sir Ganga Ram Hospital, New Delhi.

This number was shared with IANS by Dr Anil Arora, Chairman, Institute of Liver, Gastroenterology, Pancreaticobiliary Science, Sir Ganga Ram Hospital. He described it as a "double whammy of infection". He said Covid-19 treatment using steroids -- "a dampener for immunity" -- may have resulted in pus formation in the liver and the resultant abscesses.

An abscess is a mass filled with pus inside the liver, caused mainly because of an infection transmitted by bacteria, parasites, or fungi. Amoebiasis -- a common infection of the human gastro-intestinal tract -- is the most cited reason.

"India is the hub of intestinal amoebiasis. And so, it is one of the top countries reporting liver abscesses," Dr Arora, told IANS. Amoebiasis spreads from eating food or water that has been contaminated. After an infection has occurred, the parasite gets carried by the bloodstream from the intestines to the liver, where it eats up the resources of the body's central chemical factory and produces abscesses, Arora explained.

"Liver abscesses are a common occurrence and affect all socio-economic groups, but more so in poorly nourished people living in poor hygienic conditions," added Dr Atul N.C. Peters, Director, Department of Bariatric, Minimal Access and Laparoscopic Surgery, at Max Super Speciality Hospital, New Delhi.

Weight loss is not an early clinical symptom in most cases, but liver abscesses can lead to significant weight loss gradually because of loss of appetite.

"If a liver abscess is there for a long time, then the chronic infection will lead to a poor nutritional state and a gradual weight loss. But liver abscesses are not a common cause of substantial weight loss because they are present with acute symptoms and are diagnosed well in time. Some amount of weight loss (up to five to ten kilos) may be seen in liver abscess patients," Peters told IANS.

"Since the liver is enlarged, it gets swollen and causes early satiety. The person affected by a bacterial infection leading to a liver abscess may lose weight because the person doesn't actually feel hungry. The person, moreover, is in a catabolic state because of the infection. That is, the person's body is expending more energy than required, which might cause weight loss," explained Dr Amey Sonavane, Consultant, Gastroenterology & Hepatology, Apollo Hospitals Navi Mumbai.

Symptoms of a liver abscess usually take two to four weeks to appear. They include fever, chills, sweats, loss of appetite, weight loss, nausea, vomiting, or both, and diarrhoea, constipation, or both. These are coupled with pain in the lower right chest and in the upper right abdomen (more common) or throughout the abdomen (less common). A simple ultrasound can reveal the condition, making treatment faster, the doctors said.

"The most important way to prevent liver abscess is to maintain food and water hygiene. We must make sure the water we drink is not contaminated and raw food is washed thoroughly before cooking," Sonavane said.

Eating a variety of healthy and hygienic foods: fruit, vegetables, whole grain breads, low-fat dairy products, beans, lean meat, and fish, and drinking clean and safe water (between nine and 13 eight-ounce cups of liquids every day), can help keep liver problems at bay.