Amibiasis

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CASE
PRESENTATION
Dr.Yassin

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History
•5 years old boy admitted through
GIT clinic with :
•Hx of on/off Abdominal pain.
•bloody diarrhea and fever for
last 8 month.

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History
•There was 5 attacks . Each with
bloody stool with mucus and
documented fever.
•Abdominal pain on/off with or
without the attacks periumbilical,
colicky no radiation mild to
moderate in severity no known
aggravating or reliving factors.
•Assosiated with tenesmus.

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History
•1
st
attack occurred after swallwing
water from swimming pool.
•No vomiting.
•No jundice.
•No arthralgia.
•No rash.
•No travel.

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History
•Admitted twice in MCH due to
E.histolitica in stool .
•Received 5 courses of
metronidazole for 10 days.
•Seen in ID clinic given
metronidazole followed by furate
for 10 days.
•Bloody stool stopped but still on
off abdominal pain.

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History
•Perinatal:
•Allergy:
•Diet:
•Vaccination:
•Family history :
•Social:
unremarkable

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EXAM
•Looks well.
•Vitally stable
•Growth parameter
•Wt: 16 kg 5
th
•Ht:112 cm 50
th

•CVS,CHEST,ABDOMIN, CNS,ENT
musculoskeletal : within normal.

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LAB

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LAB

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LAB

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LAB

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LAB

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LAB

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summery
•5 years old boy Hx recurrent
Amebiasis (bloody diarrhea,
tenesmus ,abdominal pain)

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impresssion
•Chronic amibiasis.
Acute on top of chronic.
•IBD.

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Amebiasis

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introduction
•Entamoeba histolytica infection is
one of the significantly common
pathogenic protozoa
encountered in Saudi Arabia.
•Approximately 10% of the world's
population is infected by
amebiasis.

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ETIOLOGY
•Entamoeba histolytica.
•
•Entamoeba dispar.
•E. moshkovskii.
•E. coli.
•E. hartmanni.
•E. gingivalis.
•E. polecki.
A
s
y
m
p
t
o
m
a
t
ic

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ETIOLOGY
•Many patients previously
described as asymptomatic
carriers of E. histolytica based on
microscopy findings were
probably infected with E. dispar.
•Microscopy alone can’t
distinguishe between E.histolytica
and E. dispar .

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EPIDEMIOLOGY
•true prevalence of E. histolytica
infection is not known due to
inability to differentiate.
•Amebiasis is highly endemic in
Africa, Latin America, India, and
Southeast Asia.
•In KSA no data.

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EPIDEMIOLOGY
•3rd leading parasitic cause of
death worldwide
•direct fecal-oral contact are the
most common means of infection.
• Infection is established by
ingestion of parasite cysts

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CLINICAL
MANIFESTATIONS
90%
asymptomatic

10%
Amebic
colitis
<1%
Disseminated
disease
liver abscess

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CLINICAL
MANIFESTATIONS
•colicky abdominal pains
•Diarrhea .bloody and mucoid
stained
•tenesmus.
•fever . in only ⅓ of patients. But
may indicate liver involvement.

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investigation
•CBC: anemia and slight
leukocytosis
•LFT: high liver enzymes mainly
ALK if liver involved.

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investigation
•Stool examination microscopy :
•3 fresh stool samples (within 30
min of passage)
•has a sensitivity of 90% ,but
microscopy cannot differentiate
between E. histolytica and E. dispar
•Exception: unless phagocytosed
erythrocytes, which are specific for
E. histolytica.
•negative in >50% of patients with
documented amebic liver abscess.

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investigation
•ELISA : detection antigens in
stool by enzyme-linked
immunosorbent assays.
•PCR from stool.
•Serology :serum antiamebic
antibody

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investigation
•Sigmoidoscopy and/or
colonoscopy: can be performed
either to make the diagnosis of
amebiasis or to exclude other
causes of the patients'
symptoms.
•Ultrasonography, CT, or MRI : for
localization.

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differential diagnosis
•bacterial colitis (Shigella,
Salmonella, Escherichia coli,
Campylobacter, Yersinia,
Clostridium difficile) .
• viral colitis (cytomegalovirus)
• inflammatory bowel disease.

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COMPLICATIONS
•necrotizing colitis.
•toxic megacolon.
•extraintestinal extension.
•local perforation and peritonitis.
•chronic amebiasis with bouts of
abdominal pain and bloody
diarrhea

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TREATMENT
Invasive disease
metronidazole Then
followed
by
Paromomycin
Tinidazole Diloxanide
furoate
Iodoquinol
ASYMPTOMATIC
Paromomycin
Diloxanide furoate
Iodoquinol

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TREATMENT
•E. histolytica infection is
asymptomatic in about 90% of
persons, but it has the potential to
become invasive and should be
treated.

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PREVENTION
•Hand washing.
•Clean bathrooms and toilets often.
• Avoid sharing towels.
•Avoid raw vegetables when in
endemic areas.
•Boil water.

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THANK
YOU