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SP6-3 Fermented sap of spiky Palmyra toddy (borassus flabellifer) suggested as a vehicle of transportation of amoebiasis in the district of mannar, Sri Lanka: 50 cases of amoebic liver abscess within 15 months
  1. K Fernando1,
  2. R Fernando1,
  3. A Kandasami1,
  4. R Jude2,
  5. N Fernando1,
  6. S Tennakoon3
  1. 1District General Hospital Mannar, Mannar, Sri Lanka
  2. 2Regional Director Health service, Mannar, Sri Lanka
  3. 3Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka

Abstract

Introduction Hepatic abscess is the commonest extraintestinal manifestation of Entamoeba histolytica, the agent of amoebiasis. Mannar is a district of Northern Province in Sri Lanka where resettlement is in progress, following end of the conflict. Locally fermented sap of Palmyrah (Toddy) is a popular alcoholic drink here.

Method A retrospective case series was of all patients with confirmed amebic liver abscess over 15 months from 2009 July at District General Hospital Mannar. All available inpatient records were reviewed. Age, sex, address, chief complaint, vital signs, physical and laboratory findings, ultrasonography findings and the toddy consumption of the patients were considered.

Results 50 patients were reviewed: mean age was 46.5 years, no female cases were reported. Toddy consumption was reported by 96% of patients. The most common complaint was fever (100%) and then abdominal pain (90%) often located in the right upper quadrant and chest pain on right side (26%). The majority (92%) had symptoms for <2 weeks. Commonest physical finding was right hypochondriac tenderness (88%). The WBC count was the most consistent laboratory abnormality (88%), whereas the liver enzyme levels were often normal. Ultrasonography shows 85% of the abscesses on right and 19% on left side. Ampicillin and Metronidazole were the drugs of choice (88%).

Conclusion The Palmyra toddy has been suggested as a vehicle of transportation of the amoeba.

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