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AMOEBA Amebic colitis affects both sexes equally.

Amebiasis is an infection caused by the protozoal Age:


organism Entamoeba histolytica and includes amebic -Young children appear to be at higher risk for fulminant
colitis and liver abscess. invasive disease, resulting in a higher mortality rate
Transmission usually occurs by food-borne exposure, Clinical presentation
particularly when food handlers are shedding cysts or food History:
is cultivated in feces-contaminated soil, fertilizer, or water. Amebic colitis
Less common means of transmission include contaminated 1.Dysentry
water, oral and anal sexual practices, and direct rectal Mobile dysentery as patients not usually very sick looking
inoculation through colonic irrigation devices. as in bacillary dysentery where patients are bed ridded.
Pathophysiology: 2.Fulminant colitis
-E histolytica is a pseudopod-forming, nonflagellated Fulminant or necrotizing colitis is the most serious
protozoal parasite that exerts a lytic effect on tissue, a manifestation, has high a mortality rate. Predisposing
characteristic for which the organism is named. factors for fulminant colitis include Poor nutrition,
-Host cells are killed via the induction of apoptosis; Pregnancy, corticosteroid use, very young age
therefore, the parasite does not kill the host cell but rather 3.Chronic post amoebic colitis
induces its self-destruction. -Sclerotic changes in the bowel
-Incubation period is 2-26 days with majority 14 days. -Irritable bowel
Infective dose >103 organisms -No amoeba in the stool
- Ingestion of the cyst is followed by excystation in the 4.Amoeboma of the colon or rectum
small bowel and trophozoite colonization of the colon. -Can be ,mistaken for colorectal cancer but responds well
Upon colonization of the colonic mucosa, the trophozoite by medical treatment
may encyst and be excreted in the feces or it may invade 5.Perfoaration
the intestinal mucosal barrier, thereby gaining access to the Amoebia peritonitis
circulation, resulting in involvement of the liver, lung, and Pericolic abcess
other sites. Internal intestinal fistula.
-Whether infection results in colonization or invasion, the Amoebic dysentery may present as:
E histolytica strain and its interaction with bacterial flora; 1) Several weeks of abdominal pain, diarrhea, and bloody
host genetic susceptibility; and factors such as stools.
malnutrition, sex, age, and immunocompetence may 2) Fever is uncommon and occurs in approximately 10-
influence the infection. 30% of patients.
Liver involvement occurs following invasion of E 3) Weight loss is a common complaint and may be
histolytica into mesenteric venules. Amebae then enter the accompanied by symptoms of volume depletion (eg,
portal circulation and travel to the liver where they orthostasis).
typically form large abscesses. The abscess contains Amebic liver abscess
acellular proteinaceous debris, which is thought to be a 1) Fever and right upper quadrant abdominal pain
consequence of induced apoptosis and is surrounded by a .Unlike amebic colitis, amebic liver abscess is associated
rim of amebic trophozoites invading the tissue. with fever in 85-90% of patients.
The right lobe of the liver is more commonly affected than 2) Most do not have concomitant colitis, although a history
the left lobe. This has been attributed to the fact that the of dysentery may be obtained.
right lobe is supplied predominantly by the superior -History of alcohol abuse is common
mesenteric vein, whereas the left lobe is supplied by the Clinically, almost all patients reveal an enlarged liver and
splenic vein. tenderness in the right upper quadrant.
NB. Patients with amoebic dysentery are not infective- Polymorphonuclear leukocytosis is usually 15,000 to
passing trophozoites. 20,000/mL, and there is moderate anemia
Morbidity Pleuropulmonary amebiasis
-E.histolytica probably is second only to malaria as a -Rare but serious complication of amebic liver abscess,
protozoal cause of death. -Caused rupture of a superior right upper lobe abscess with
-Asymptomatic intestinal infection occurs in 90-99% of erosion through the diaphragm.
infected individuals. -Patients with this complication present with cough,
- Most infected individuals eliminate the parasite from the pleuritic chest pain, dyspnea, and, occasionally, necrotic
gut within 12 months; however, colonization with E sputum.
histolytica carries a low but definite risk of developing Intraperitoneal rupture
into invasive amebiasis. From amebic liver abscess occurs. These patients can
-Amebic colitis is complicated by fulminant or necrotizing present with a rigid abdomen that may be diagnosed
colitis with high mortality rate. erroneously as a perforated viscus.
-Amebic liver abscess is complicated by intraperitoneal Cerebral amebiasis
rupture. -Is a rare cause of brain abscess and is characterized by an
Sex: abrupt onset of mental status change and/or focal
-Amebic liver abscess is 7-12 times more common in men neurologic deficits.
than in women, although the sex distribution is equal in -Progression to death occurs over 12-72 hours without
children. adequate therapy.
-. INVESTIGATIONS
Physical examination LAB
Amebic colitis FHG-Lecocytosis with eosinophilia-Amaeboma
-Fever-some patients Presence of PMN cells predominant-Liver abscess
-Weight loss Anemia may occur.
-Diffuse abdominal tenderness ESR-elevated
-Heme-positive stools Microscopy
-Patients with fulminant colitis are more likely to present -Finding quadrinucleated cysts or trophozoites containing
with abdominal pain, distension, and rebound tenderness. ingested erythrocytes in stool is considered by many to be
Amebic liver abscess diagnostic for amebic colitis.
-Fever Antigen detection
-Right upper quadrant abdominal tenderness -A stool antigen test specific for E histolytica is available
-Durbans sign-intercostal tenderness consistent sign of - Monoclonal antibodies specific for the galactose (Gal)/N-
amoebic dysentery. acetyl-D-galactosamine (GalNAc) lectin of E histolytica