amibiasis
TRANSCRIPT
Page 1
CASE PRESENTATION
Dr.Yassin
Page 2
History
• 5 years old boy admitted through GIT clinic with :
• Hx of on/off Abdominal pain.
• bloody diarrhea and fever for last 8 month.
Page 3
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.
Page 4
History
• 1st attack occurred after swallwing water from swimming pool.
• No vomiting.
• No jundice.
• No arthralgia.
• No rash.
• No travel.
Page 5
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.
Page 6
History
• Perinatal:
• Allergy:
• Diet:
• Vaccination:
• Family history :
• Social:
unremarkable
Page 7
EXAM
• Looks well.
• Vitally stable
• Growth parameter
• Wt: 16 kg 5th
• Ht:112 cm 50th
• CVS,CHEST,ABDOMIN, CNS,ENT musculoskeletal : within normal.
Page 8
LAB
Page 9
LAB
Page 10
LAB
Page 11
LAB
Page 12
LAB
Page 13
LAB
Page 14
summery
• 5 years old boy Hx recurrent Amebiasis (bloody diarrhea, tenesmus ,abdominal pain)
Page 15
impresssion
• Chronic amibiasis. Acute on top of chronic.
• IBD.
Page 16
Amebiasis
Page 17
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.
Page 18
ETIOLOGY
• Entamoeba histolytica.
•
• Entamoeba dispar.
• E. moshkovskii.
• E. coli.
• E. hartmanni.
• E. gingivalis.
• E. polecki.
Asym
ptomatic
Page 19
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 .
Page 20
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.
Page 21
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
Page 22
CLINICAL MANIFESTATIONS
90% asymptomatic
10%Amebic colitis
<1% Disseminated
disease liver abscess
Page 23
CLINICAL MANIFESTATIONS
• colicky abdominal pains
• Diarrhea .bloody and mucoid stained
• tenesmus.
• fever . in only ⅓ of patients. But may indicate liver involvement.
Page 24
investigation
• CBC: anemia and slight leukocytosis
• LFT: high liver enzymes mainly ALK if liver involved.
Page 25
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.
Page 26
investigation
• ELISA : detection antigens in stool by enzyme-linked immunosorbent assays.
• PCR from stool.
• Serology :serum antiamebic antibody
Page 27
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.
Page 28
differential diagnosis
• bacterial colitis (Shigella, Salmonella, Escherichia coli, Campylobacter, Yersinia, Clostridium difficile) .
• viral colitis (cytomegalovirus)
• inflammatory bowel disease.
Page 29
COMPLICATIONS
• necrotizing colitis.
• toxic megacolon.
• extraintestinal extension.
• local perforation and peritonitis.
• chronic amebiasis with bouts of abdominal pain and bloody diarrhea
Page 30
TREATMENTInvasive disease
metronidazole Then followed
by
Paromomycin
Tinidazole Diloxanide furoate
Iodoquinol
ASYMPTOMATIC
Paromomycin
Diloxanide furoate
Iodoquinol
Page 31
TREATMENT
• E. histolytica infection is asymptomatic in about 90% of persons, but it has the potential to become invasive and should be treated.
Page 32
PREVENTION
• Hand washing.
• Clean bathrooms and toilets often.
• Avoid sharing towels.
• Avoid raw vegetables when in endemic areas.
• Boil water.
Page 33
Page 34
THANK YOU