Amebiasis is an infection with the intestinal protozoan Entamoeba histolytica. About 90% of infections are asymptomatic, and the remaining 10% produ…
Amebiasis is an infection with the intestinal protozoan Entamoeba histolytica. About 90% of infections are asymptomatic, and the remaining 10% produce a spectrum of clinical syndromes ranging from dysentery to abscesses of the liver or other organs.
Amebiasis results from infection with E. histolytica and is the third most common cause of death from parasitic disease after schistosomiasis and malaria. Most asymptomatic carriers, including homosexual men and patients with AIDS, harbor E. dispar and have self-limited infections.
Areas of highest incidence due to inadequate sanitation and crowding include most developing countries in the tropics.
The main groups at risk for amebiasis in developed countries are returned travelers, recent immigrants, homosexual men, and inmates of institutions.
Clinical Syndromes Intestinal Amebiasis
The most common type of amebic infection is asymptomatic cyst passage. Even in highly endemic areas, most patients harbor E. dispar.
Symptomatic amebic colitis develops 2-6 weeks after the ingestion of infectious cysts.
A gradual onset of lower abdominal pain and mild diarrhea is followed by malaise, weight loss, and diffuse lower abdominal or back pain. Cecal involvement may mimic acute appendicitis.
Patients with full-blown dysentery may pass 10-12 stools per day. The stools contain little fecal material and consist mainly of blood and mucus.
More fulminant intestinal infection, with severe abdominal pain, high fever, and profuse diarrhea, is rare and occurs predominantly in children.
Patients may develop toxic megacolon.
patients develop a chronic form of amebic colitis, which can be confused with inflammatory bowel disease.
Amebic Liver Abscess.
Extra intestinal infection by E. histolytica most often involves the liver. Most patients are febrile and have right-upper-quadrant pain, which may be dull or pleuritic in nature and may radiate to the shoulder. Point tenderness over the liver and right-sided pleural effusion are common. Jaundice is rare with weight loss and hepatomegaly.
Complications of Amebic Liver Abscess.
Pleuro pulmonary involvement in patients, is the most frequent complication of amebic liver abscess.
Manifestations include sterile effusions, contiguous spread from the liver, and rupture into the pleural space.
Abscesses that rupture into the peritoneum may present as an indolent leak or an acute abdomen.
Rupture into the pericardium, usually from abscesses of the left lobe of the liver, carries the gravest prognosis, it can occur during medical therapy and requires surgical drainage.
Other Extraintestinal Sites.
The genitourinary tract may become involved by direct extension of amebiasis from the colon or by hematogenous spread of the infection. Painful genital ulcers, characterized by a punched-out appearance and profuse discharge, may develop secondary to extension from either the intestine or the liver.
Laboratory Diagnosis 1.Stool examinations 2.serologic tests 3.noninvasive imaging of the liver 4.Routine hematology and chemistry tests 5.Radiographic techniques such as oUltrasonography oCT oMRI Differential Diagnosis bacterial diarrheas caused by 1.Campylobacter 2.Enteroinvasive Escherichia coli 3.Species of Shigella
4.Salmonella and Vibrio
Mercurius corrosives: All the preparations of mercury act on the intestines, producing bloody stools with tenesmus, and
Mercurius corrosivus is the one usually thought of in this affection, as its symptoms corresponds to many severe cases.
In the first place we have severe and extreme tenesmus; this is the great characteristic of the
painful tenesmus,and at the same time there is much tenesmus of the bladder,the stools are scanty, of mucous shreds and blood and there is great burning at the anus.
Arsenicum: Arsenicum is a valuable remedy in dysentery. There are scanty stools, burning in the rectum, thirst, and after the stool there is great prostration, but there is not the tympanitic distention of the abdomen The patient is restless and thirsty, water is borne badly. Stools which are undigested , slimy and bloody, indicate Arsenicum. Blackish brown, horribly offensive stools also indicate well the remedy.
The tenesmus and burning of the anus and rectum continue after stool.
This remedy, which produces such an intense vesical tenesmus, also produces a like condition in the rectum.
Its characteristics are bloody and slimy discharges which look like the scrapings of the intestines, which are nothing but the fibrous exudations from the disease.
Tenesmus is marked, and always with Cantharis there is a painful urination, and there is present a colic-like pain doubling the patient doubles up.
For persistent or chronic cases of dysentery Sulphur is the remedy.
The tenesmus continues, in fact there is a sort of tenesums all the time, the stools are slimy and there is frequent sudden urging to stool.
Sometimes this condition is present without the tenesums.
In Nux the tenesums ceases after stool and the pains are relieved for a short time it is similar to Sulphur in its frequent urging.
The stools are bloody, slimy, scanty and watery,and the patient is worse in the morning.
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