Rapid Diagnosis of Amoebic Liver Abscess Using Gastrointestinal Multiplex PCR Panel in Pediatrics
Overview
This report describes three pediatric cases of amoebic liver abscess diagnosed rapidly and accurately using the FilmArray Gastrointestinal multiplex PCR panel applied off-label on liver abscess fluid. This approach enabled timely targeted antiamoebic therapy and favorable clinical outcomes.
Background
Amoebic liver abscess, caused by Entamoeba histolytica, is a serious extraintestinal complication occurring in about 1% of infected individuals and is a leading cause of death from parasitic diseases worldwide. Traditional immunodiagnostic methods have limitations, especially in high-prevalence regions, due to delayed antibody detection and potential false positives. Molecular diagnostic tools like multiplex PCR panels have revolutionized pathogen detection in stool samples, but their off-label use on other specimen types remains underexplored. This report highlights the utility of such molecular diagnostics directly on liver abscess fluid in pediatric patients.
Data Highlights
Patient
Age
Abscess Size (cm)
Initial Empirical Therapy
GIFA Result
Outcome
1
5 years
6.1
Ceftriaxone + Metronidazole
Positive for E. histolytica
Clinical improvement after therapy adjustment
2
5 years
8.6
Amikacin, then Cefotaxime + Metronidazole
Positive for E. histolytica
Complete recovery after therapy adjustment
3
17 months
3.6
Piperacillin–tazobactam + Metronidazole
Positive for E. histolytica
Improvement after drainage and therapy adjustment
Key Findings
The FilmArray Gastrointestinal multiplex PCR panel detected E. histolytica DNA directly from liver abscess fluid, an off-label specimen type.
This molecular approach enabled rapid and accurate diagnosis in all three pediatric cases where routine microbiology and fecal studies were negative.
Use of the multiplex PCR panel facilitated timely discontinuation of broad-spectrum antibiotics and initiation or continuation of targeted antiamoebic therapy.
All patients showed favorable clinical outcomes following diagnosis and appropriate treatment adjustments.
The method shows promise for use in resource-limited, high-burden settings but requires further validation.
Clinical Implications
Applying multiplex gastrointestinal PCR panels directly to liver abscess fluid can significantly improve the speed and accuracy of amoebic liver abscess diagnosis in children. This allows clinicians to tailor antimicrobial therapy promptly, avoiding unnecessary broad-spectrum antibiotics and improving patient outcomes. However, clinicians should be aware that this is an off-label use and further studies are needed to establish standardized protocols.
Conclusion
Off-label use of the FilmArray Gastrointestinal multiplex PCR panel on liver abscess fluid offers a rapid, sensitive diagnostic tool for amoebic liver abscess in pediatric patients, enabling targeted therapy and favorable outcomes. This approach holds potential for broader application pending further validation.
References
Article Source 2024 -- Utilization of Gastrointestinal Multiplex PCR Panel for Diagnosing Amoebic Liver Abscess: A Report on Three Pediatric Cases
