A Family Doctor's Tale - AMEBIASIS

DOC I HAVE AMEBIASIS

Amebiasis is an acute infectious illness caused by the  parasite Entoameba histolytica.

The bacteria which causes Amebiasis is the Entmoeba histolytica which is an extremely hardy parasite able to live in  polluted water, contaminated food and soiled clothes.

Amebic infections occur most common in the caecum and rectosigmoid region of the colon.

Initial infections are small ulcers, usually discrete erosions which may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.

Penetration through the muscle lining may occur causing peritonitis.

Liver involvement may occur with the ameba traveling through the portal vein.

Liver abscesses consists of necrotic liver tissue.

Secondary bacterial infection are rare.

Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.

Single and multiple liver abscesses may occur shortly after a bout of amebic dysentery.

Abscesses of the brain and lung may occur.

Ulcers heal rapidly after treatment and permanent scarring is rare.

The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carriers

2. Invasive bowel disease begins 1-6 months after infection sometimes later

3. abdominal pain especially at the lower flanks

4. altered bowel habit

5.diarrhea with blood or mucus in stools

6.foul stools

7.adominal bloating or gas

8.tenderness on palpation at caecum or sigmoid colon regions

Severe cases may have:
1.more severe symptoms as above

2.bloody stools

3.fever

4.weight loss

5.liver enlargement and tenderness on palpation

6.dehydration and its effects such as delirium and disorientation

7. lassitude and tiredness

8. convulsions

9.tender abdominal mass with obstruction

Doctors generally diagnose Amebiasis based on:
1. stool cultures.

2.blood tests

3.colonoscopy

4.liver scan and ultrasound

The complications of Amebiasis are:

Amebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or intra-abdominal abscesses

2.Severe hemorrhage uncommon but can cause death

3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction

4.irritable bowel syndrome may persist for some months

5.Lung and pericardial involvement rare but can pose danger

6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration

7.Liver infection can cause damage to liver and result in cirrhosis

8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis

9.Amebic brain abscess are rare but can occur.

Treatment of Amebiasis is by the following:

Amebiasis is an infectious disease which can spread to other people through contaminated food and water and must be treated as soon as possible.


Medicines:

1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.

2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis

3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery

4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.

5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache

2.antispasmodic drug to stop abdominal cramps

3.medicine to harden the stools such as kaolin

4.slow down the intestinal movement (lomotil or loperamide).

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

Get plenty of rest.

Prevention of Amebiasis can be by:
1.boil drinking and cooking water for 5 minutes

2.Proper filtration of water

3.Examination of stools of food handlers

4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies

5.Good food hygience and hand washing

Prognosis depends on the stage of disease

It is excellent with prompt treatment of amebic infection.

Luminal disease or dysentery usually respond well to treatment.

In refractory cases chloroquine may be added to metronidazole.

Surgery is rarely necessary.