Amebic Liver Abscess: Current Concepts in Epidemiology, Pathogenesis, Diagnosis, and Management

Amebic liver abscess (ALA) remains the most common extraintestinal manifestation of Entamoeba histolytica infection and continues to impose substantial morbidity and mortality, particularly in tropical regions. This review provides a narrative synthesis of current evidence on epidemiology, pathogenesis, clinical features, diagnosis, and management of ALA, with a focus on sex-specific differences, alcohol-associated risk, immune mechanisms, and evolving diagnostic and therapeutic strategies. A comprehensive literature search of PubMed, Scopus, and Google Scholar was performed using the terms “amoebic liver abscess,” “ Entamoeba histolytica ,” “diagnosis,” “management,” “immunity,” and “complications.” Additional studies were identified from reference lists. Relevant clinical and experimental studies were screened, and data were narratively synthesized to provide a state-of-the-art overview. ALA shows a striking male predominance, with alcohol use, hormonal influences, and immunological differences contributing to susceptibility. Clinical presentation ranges from mild subacute disease to severe illness complicated by rupture, vascular thrombosis, biliary involvement, and sepsis. Ultrasonography remains the initial diagnostic modality, while serology and molecular tests significantly enhance etiologic confirmation, particularly in nonendemic settings. Metronidazole continues as the cornerstone of therapy; however, optimal drainage strategies, catheter size, timing, and duration remain incompletely defined. Novel biomarkers, molecular assays, and point-of-care tests are rapidly improving diagnostic accuracy, particularly in resource-limited settings. Despite therapeutic advances, delayed diagnosis, large abscesses, and complications such as rupture, thrombosis, and biliary communication continue to determine outcomes. Future priorities include standardization of interventional protocols, improved access to diagnostics, and deeper understanding of host–parasite interactions to guide targeted therapies.