Amebiasis (pronouncing am-uh-BYE-eh-sis) is a disease of the human intestine. Amoebosis is associated with impurity and poor health rather than air. It is distributed worldwide. It is a major health problem in China, East and East Asia, Latin America, especially Mexico.
Most people with Entamoeba histolytica are asymptomatic with no bowel disease. Currently, symptoms associated with E histolytica usually include cramping, watery or bloody diarrhea, and weight loss. Sometimes the virus can spread to other organs, usually the liver (liver abscess), and can cause fever and pain in the upper right part. The disease is more severe in adolescents, the elderly, vegetarians and pregnant women. In people with symptoms of intestinal amoebosis, symptoms usually start gradually over 1 to 3 weeks. The most common type of intestinal infection is heterogeneous colitis. Amoebic dysentery is the most common symptom of amoebosis and usually includes diarrhea with blood or blood in the stool, abdominal pain, and a feeling of tightness. Weight loss is due to its slow growth, but fever is less common in patients (8-38%).
Symptoms:
Symptoms can be chronic and have symptoms caused by changes in the duration of diarrhea and gastrointestinal upset, which can worsen symptoms of gastrointestinal illness. Involvement of the gastrointestinal tract can lead to toxic megacolon, fulminant colitis, colonic and perianal ulcers, and rare perforations. Colonic growth can occur at multiple sites and have a high death rate.
The growth can occur in patients who are not treated well with corticosteroids or anticinetic drugs. Amibaoma can occur as a condition of the large intestine and may take on a palpable size on physical examination.
Amibomas can occur in any part of the gastrointestinal tract, but they usually occur in the extracellular fluid. It can be confused with leukemia. Amibaoma is usually resolved with anti-amoeba therapy and does not require surgery.
Symptoms can be prolonged, and there are symptoms of diarrhea and bowel problems that change over time, which can make symptoms of gastrointestinal illness worse. Involvement of the gastrointestinal tract can lead to toxic megacolon, fulminant colitis, colonic and perianal ulcers, and rare perforations. Colonic growth can occur at multiple sites and have a high death rate.
The growth can occur in patients who are not treated well with corticosteroids or antidiabetic drugs. Amibaoma can occur as a condition of the large intestine and may take on a palpable size on physical examination. Amibomas can occur in any part of the gastrointestinal tract, but they usually occur in the extracellular fluid. It can be confused with leukemia. Amibaoma is usually treated with anti-amoebic therapy and does not require surgery.
Causes of Amebiasis
The genus Entamoeba includes the species that live in the human stomach. The four species, E histolytica, Entamoeba dispar, Entamoeba moshkovskii and Entamoeba bangladeshi, are morphologically identical. Not all types of entamoeba are toxic. E dispar is generally recognized as positive and E moshkovskii is often considered non-infectious, but may be associated with diarrhea in infants. Entamoeba species are excreted as vesicles or trophozoites in the stools of patients.
Epidemiology
E histolytica can be found all over the world, but in some communities it is more common in less healthy people than in resource-limited countries where the disease is transmitted.
The amoeba can reach 50%. In developed countries, high-risk groups include migrants or long-term visitors from infected areas, institutionalized people, and men who have sex with men.
E histolytica is transmitted by amoebic cysts via the fecal-oral route. Insensitive to stomach acid, eating cysts swells in the alkaline small intestine, creating nutrients that are passed to the intestine. Cysts that form later are responsible for transmission, especially the asymptomatic cyst. Patients get cysts regularly, sometimes for years if left untreated. Transmission is associated with contaminated food or water. Fecal contamination can occur in the rectum or rectum area directly from the colon irrigating material.
The incubation period varies from a few days to a few months or years, but is usually 2-4 weeks.
Diagnostic Tests
Diagnosis of intestinal pathogens depends on the identification of trophozoites or cysts in the stool. Examination of production models may be necessary. Fecal samples can be wet-tested within 30 minutes of collection or soaked in formalin or polyvinyl alcohol (included in the kit) for hardening, discoloration and after microscopy.
The diet with more red blood cells may be E histolytica, but microscopy does not distinguish E histolytica from fewer bacteria. Antibiotic kits are available in some laboratories to test for E histolytica directly in the stool. The benefit of examining biopsy samples and endoscopic scraping (without swabbing) using similar procedures is not necessary. Polymerase chain reaction and isoenzyme assays can differentiate E histolytica from E dispar, E moshkovskii and other Entamoeba species. Some antigens based on monoclonal antibodies can differentiate E histolytica by E dispar.
The indirect hemagglutination test (IHA) was performed using commercially available enzyme-linked immunosorbent assay (EIA) equipment using modern serological diagnostics for amoebosis. EIA detects immunodeficiency virus specific for E histolytica in approximately 95% or more of patients with gastrointestinal amoebosis, 70% of patients with gastrointestinal disease, and 10% of asymptomatic patients through cysts E histolytica.
The patient can enjoy good serological benefits even after the necessary treatment. Diagnosis of E. histolytica hepatic abscesses and other gastrointestinal disorders is facilitated by serological examination because stool and aspirated abscesses usually do not occur. Ultrasound, computed tomography, and magnetic resonance imaging can detect liver abscesses and other areas of extraintestinal disease. Aspirations from liver abscesses usually do not show nutrients or white blood cells.
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Prevention
Amoebiasis can be prevented and controlled with specific and specific measures.
Non-specific measures:
- Improved water – cysts are not killed by goats used to kill water. Filtration and boiling of water is better than water treatment for amoebiasis.
- Hygiene – Safe disposal of human feces, including hygiene of hand washing after defecation and always before handling and eating
- Safety Precautions – Fruits and vegetables should be washed thoroughly in potable water, peeled and boiled before vegetables can boil. It should also include measures to protect food and drink from flies and cockroaches and to control these pests. Carriers who have passed through the blisters and are involved in home food handling, street vendors or manufacturers are the primary carriers of amoebiasis and need to be diagnosed and treated
- Health education for the general public as well as health workers at all levels about hygiene and food hygiene – through early campaigns through schools, health care units and in-house media through basic hygiene practices. Advertising and constant strengthening should be done
- General Social and Economic Development – Implementing individual and collective precautions (such as hand washing, proper disposal) should be an integral part of these activities.
Specific measures
- Community surveys to monitor the status of local epidemics regarding amoebiasis
- Improving case management, ie rapid diagnosis and appropriate treatment of patients with invasive amoebiasis at all levels of health services, including community and health center levels.
- Monitor and control conditions that may further promote the spread of amoebosis (eg, refugee camps, public sewers).
Treatment
Now we come to the treatment of Amebiasis.
Treatment should be prioritized for all patients with E histolytica, including those who are asymptomatic, given the propensity of this organism to cause invasive infection and to spread among family members.
A treatment plan should include antimicrobials to eliminate invading trophozoites as well as organisms carried in the intestinal lumen. Corticosteroids and antimotility drugs administered to people with amebiasis can worsen symptoms and the disease process. In settings where tests to distinguish species are not available, treatment should be administered to symptomatic people on the basis of positive results of microscopic examination.
The following regimens are recommended:
Asymptomatic cyst excreters (intraluminal infections): treat with an intraluminal amebicide alone (paromomycin or diiodohydroxyquinoline/iodoquinol, or diloxanide furoate). Metronidazole is not effective against cysts.
Patients with invasive colitis manifest as mild to moderate or severe intestinal tract symptoms or extraintestinal disease (including liver abscess): treat with metronidazole or tinidazole, followed by an intraluminal amebicide or diloxanide furoate or, in the absence of intestinal obstruction, paromomycin. Nitazoxanide may be effective for mild to moderate intestinal amebiasis, although it is not approved by the US Food and Drug Administration for this indication.
Percutaneous or surgical aspiration of large liver abscesses occasionally may be required when response of the abscess to medical therapy is unsatisfactory or there is risk of rupture. In most cases of liver abscess, however, drainage is not required and does not speed recovery
Follow-up stool examination is recommended after completion of therapy, because no pharmacologic regimen is completely effective in eradicating intestinal tract infection. Household members and other suspected contacts should have adequate stool examinations performed and should be treated if results are positive for E histolytica
Patient’s Images:
This patient presented with a case of invasive extraintestinal amebiasis affecting the cutaneous region of the right flank. Courtesy of Centers for Disease Control and Prevention.
This patient, also shown in Image 1.1, presented with a case of invasive extraintestinal
amebiasis affecting the cutaneous region of the right flank causing severe tissue necrosis.
Here we see the site of tissue destruction, pre-debridement. Courtesy of Centers for
Disease Control and Prevention/Kerrison Juniper, MD, and George Healy, PhD, DPDx.
References:
- http://www.cdc.gov
- CMDT Book