Amebiasis

Amebiasis is a parasitic infection caused by the amoeba Entamoeba histolytica. It is a common cause of diarrhea in developing countries, and it can also cause severe disease, including amoebic dysentery and liver abscesses. In this article, we will discuss the case, pathophysiology, signs and symptoms, investigation, treatment, and advice for patients with amebiasis.

Case:Mrs. X, a 38-year-old woman, presented to the clinic with complaints of abdominal pain, cramps, and loose stools for the past 10 days. She also reported fever, chills, and weight loss. Her medical history was unremarkable, and she had no previous history of gastrointestinal disease. On examination, her abdomen was tender, and there was mild hepatosplenomegaly. A stool examination was done, which showed the presence of Entamoeba histolytica trophozoites. Based on the clinical presentation and laboratory findings, a diagnosis of amebiasis was made.

Pathophysiology:
The Entamoeba histolytica parasite is transmitted through the ingestion of contaminated food or water. The parasite can exist in two forms: the trophozoite, which is the active form, and the cyst, which is the dormant form. The trophozoites invade the intestinal wall, causing inflammation and ulceration, leading to diarrhea, abdominal pain, and cramps. In severe cases, the parasite can spread to other organs, causing liver abscesses, lung abscesses, or brain abscesses.

Signs and Symptoms:
The signs and symptoms of amebiasis can vary from mild to severe. They include:

Diarrhea (often with blood and mucus)
Abdominal pain and cramps
Fever and chills
Fatigue
Weight loss
Nausea and vomiting
In severe cases, the parasite can spread to other organs, causing additional symptoms, such as:

Liver abscesses (upper right quadrant pain, fever, jaundice)
Lung abscesses (cough, chest pain, shortness of breath)
Brain abscesses (headache, confusion, seizures)
Investigation:
The diagnosis of amebiasis is based on clinical presentation, laboratory findings, and imaging studies. Laboratory tests that can aid in the diagnosis of amebiasis include:

Stool examination: Identification of Entamoeba histolytica trophozoites or cysts in stool samples
Serology: Detection of antibodies to Entamoeba histolytica in blood samples
Imaging studies: Ultrasound or CT scan to detect liver or lung abscesses
Treatment:
The treatment of amebiasis involves the use of antimicrobial agents, such as metronidazole, tinidazole, or nitazoxanide. In addition, supportive care, such as rehydration and electrolyte replacement, may be necessary for patients with severe diarrhea. In cases of liver abscesses, drainage may be necessary to remove the pus.

Dos and Don’ts:
To prevent the transmission of Entamoeba histolytica, it is important to follow good hygiene practices, such as washing hands before eating, and avoiding the consumption of contaminated food and water. Patients with amebiasis should be advised to:

Take the prescribed antimicrobial agents as directed by the physician
Drink plenty of fluids to prevent dehydration
Avoid alcohol consumption during treatment
Avoid sexual activity during treatment to prevent the spread of the infection
Follow-up with their physician as directed to ensure complete recovery

References:

Stanley SL Jr. Amoebiasis. Lancet. 2003 Mar 22;361(9362):102

Petri WA Jr, Haque R. Entamoeba histolytica. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 292.

Shirley DA, Moonah SN. Fulminant amebic colitis after corticosteroid therapy: a systematic review. PLoS Negl Trop Dis. 2016 Apr 14;10(4):e0004604.

WHO. Amoebiasis. Available from: https://www.who.int/news-room/fact-sheets/detail/amoebiasis

Stanley SL Jr. Amoebiasis. Lancet. 2003 Mar 22;361(9362):102.

Blessmann J, Ali IK, Nu PA, et al. Longitudinal study of intestinal Entamoeba histolytica infections in asymptomatic adult carriers. J Infect Dis. 2003 Jul 15;188(2):227-33.

Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev. 2003 Oct;16(4):713-29.

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