AMEBIASIS

Infection caused by Entamoeba

90 % cases are asymptomatic First described by Lsch (1875) from a patient in Leningrad and discovered a trophozoit form Quinche & Roos (1893) discovered a cyst form Walker & Sellards proved that E, hystolytica caused amebic colitis

hystolytica

ETIOLOGY
Entamoeba hystolytica (pathogen ) & Entamoeba dispar (apathogen) E. hystolytica :

Trophozoit : hystolytica & minuta 20-40 um (12-50 um), round nucleus, endoplasma (food vacuoles RBC, phagocytized elements), clear ectoplasma Cyst : 10-20 um, oval or round, 1 4 nuclei

Entamoeba hystolytica
LIFE CYCLE ..(1)
Infective cyst is ingested the wall is digested in small intestines released of 4 quadrinucleat ameba. Passed into large intestine to grow and divide by binary fision to form trophozoites Trophozoites live in the lumen and mucosal crypt of the large bowel (caecum, descending colon, recto-sigmoid)

Entamoeba hystolytica

LIFE CYCLE ..(2)

Invasion of mucosa and passage via bloodstream may occur colitis, liver abscess In the absent of diarrhea, trophozoites round up and encyst in the lumen of large intestines (never in the tissue) passed in the faeces Within few hours cysts are infected

EPIDEMIOLOGY
Worldwide , tropical region Infect 10 % of world population Third cause of death among parasitic diseases (schistosomiasis, malaria) Relevent factors in transmission : fecal disposal, water-borne infections, food handlers, personal hygiene, arthropodes as mechanical vectors. Humans are the principal reservoir

PATHOGENESIS
Trophozoites in the intestinal lumen Depletion of intestinal mucus, diffuse inflammation, disruption of the epithelial barrier Attach to the interglandular epithel Microulceration of the mucosa (cecum sigmoid colon, rectum) Submucosal extension of ulceration flask shaped ulcer

CLINICAL MANIFESTATION .. (1)

Asymptomatic cyst passage intestinal amebiasis fulminant disease Asymptomatic cyst passage most common type persistent state symptomatic form

CLINICAL MANIFESTATION (2)

Symptomatic amebic colitis develops 2-6 weeks after ingestion of infected cyst lower abdominal pain, mild diarrhea malaise, weight loss full blown dysentriae stool : little fecal material, blood, mucus

CLINICAL MANIFESTATION .(3)

Toxic megacolon fulminant intestinal infection high fever, profused diarrhea, severe abdominal pain, severe bowel dilatation with intramural air children, geriatric, steroid Chronic amebic colitis uncommon, mimic IBS

CLINICAL MANIFESTATION .(4)

Ameboma (amebic granuloma) excessive production of granulation tissue cecum, rectosigmoid present as an irregular tumor pain, palpable mass, obstructive symptoms, haemorrhage

CLINICAL MANIFESTATION .(5)

Amebic liver abscess preceded by intestinal colonization trophozoites invade vein through portal systems liver parenchyma is replaced by necrotic materials anchovy paste) surrounded by a thin rim of congested liver tissue ameba may be found near the capsule of the abscess

CLINICAL MANIFESTATION ..(6)

Amebic liver abscess febrile, right upper quadrant abdominal pain radiate to the shoulder, hepatomegaly, weight loss elevated right dome of diaphragm on chest X ray complication : rupture amebic empyema, peritonitis, pericarditis, cardiac tamponade

CLINICAL MANIFESTATION ..(7)

Other form of extraintestinal amebiasis - Cutaneus and genital amebiasis - Pleuropulmonary amebiasis - Brain abscess

DIAGNOSIS (1)
Anamnesis Physical diagnosis Laboratory - Stool : E. hystolytica) (trophozoite) - Culture - Serology : counterimmunodiffusion, agar gel diffusion, ELISA (6-12 mo neg), IHA (up to 10 yrs)

DIAGNOSIS .(2)
Amebic liver abscess: Chest X-ray, liver scan, ultrasonography, MRI Radiographic barium harmful in acute amebic colitis. Endoscopy + biopsy in ameboma

DIFFERENTIAL DIAGNOSIS
Bacterial diarrhoea caused by Campylobacter, enteroinvasive Esche-

richia coli, Shigella sp, Salmonella sp, Vibrio sp.

Pyogenic liver abscess : older patient, underlying bowel disease, surgery

TREATMENT ..(1)
Luminal amebicides - Poorly absorbed - High concentration in the bowel - Limited to cyst & trophozoites close to mucosa - Iodoquinol, Diloxanide furoate, Paromomycin

TREATMENT ..(2)
Tissue amebicides - High concentration in blood and tissue - Metronidazole, Tinidazole, Ornidazole Aspiration of liver abscess - Diagnostic - Failure to respond clinically in 3-5 days. - To threat of imminent rupture - To prevent left lobe liver abscess rupture

PREVENTION
Adequate sanitation Eradication of cyst carriage Disinfection by iodination (tetraglycine hydroperiodide) No effective chemoprophylaxis