Amoebiasis

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Amoebiasis

  1. 1. Amoebiasis - Causes, Symptoms, Treatment <br />Definition:<br />Amoebiasis is an infection of small intestine, which is caused by an protozoan called Entamoeba histolytica. It is simply called - Amoebic dysentery. This is usually contracted by ingesting water or food contaminated by amoebic cysts. Amoebic abscesses may form in the liver , lungs , and brain and elsewhere in the body.<br />Amoebae are parasites that can be very easily found in contaminated food or drink. They enter the body through the mouth when the contaminated food or drink is swallowed. The amoebae are then able to move through the digestive system and take up residence in the intestine and cause infections like amoebiasis.<br />What is Amoebiasis and Amoeba?<br />There are several different species of amoeba, but the most dangerous, such as Entamoeba histolytica, live predominantly in tropical areas. People living in rural areas or persons traveling in such areas are at highest risk of developing this disease, which occurs when something infected with the parasite is eaten or swallowed. <br />There are mainly two types of amoebiasis:-<br />Intestinal Amoebiasis:- It is frequently asymptomatic and varies from fulminant dysentery with fever, chills, and bloody or mucoid diarrhea to mild abdominal discomfort with diarrhea containing blood or mucus alternating with periods of constipation or remission.<br />Extraintestinal Amoebiasis:- It occurs when the parasite invades other organs such as liver, lung, brain or skin. The incubation period varies from a few days to several months or years (commonly 2-4 weeks). <br />Causes of Amoebiasis:<br />The main cause of amoebiasis is- single cell parasite called entamoeba histolytica.  The parasite burrows into the wall of the intestine to cause small abscesses and ulcers . From there they enter the veins of the intestine and are carried to the liver .<br />Even though there is constant spread of infection, (within a family) some people are resistant to amoebiasis. Even if infected, they only act as a carrier to the disease and do not develop themselves. This shows that the ultimate cause of suffering is hidden than the exposed causative factor i.e. amoeba.<br />Some Possible Causes of Amoebiasis includes:-<br />Eating or Drinking contaminated water or food is one of the primary cause of amoebiasis.<br />Touching, and bringing to your mouth, cysts (eggs) picked up from surfaces that are contaminated with entamoeba histolytica.<br />Eating a food on which mosquito had sat, after sitting on the stool of a person infected with entamoeba histolytica, may lead to amoebiasis. <br />Eating vegetables and fruits which have been contaminated by the harmful bacteria, may cause amoebiasis.<br />Eating Non-Veg foods (meat and intestines of animals - goat, pig, beef, etc.), may lead to the condition of amoebiasis. <br />Even vegetables grown in soil contaminated by faeces can transmit the disease.<br />As, amoebiasis is a highly contagious disease - so, it may be transmitted from one person to other through direct contact.<br />Unhygienic Conditions and Poor Sanitation areas are more susceptible to amoebiasis.<br />Amoebic dysentery can also be spread by anal sex or directly from person to person contact.<br />Symptoms for Amoebiasis:<br />The symptoms are in two forms: <br />1. By burrowing the intestines and making ulcers, which bleed and cause anaemia or other diseases due to added infection 2. Absorbing the food from the host or letting out toxic substances in the intestines <br />Some important symptoms of amoebiasis includes:- <br />Passing of more number of stools is one of the main symptom in amoebiasis. In this case, patient may pass about 10-12 stools during an acute episode. The presence of mucus is common in stools.<br />Stools can sometimes also be accompanied with blood<br />Usually symptoms start with diarrhea and pain in right hypochondrium.<br />Jaundice.<br />The other most common symptom is colic or pain in abdomen.<br />It could be associated with a low-grade fever too.<br />Sometimes allergic reactions can occur throughout the body, due to release of toxic substances or dead parasites inside the intestines.<br />Loss of Weight and Stamina is encountered with person suffering from amoebiasis.<br />Around one in ten people who are infected with amoebiasis become ill from the disease.<br />Tenesmus, may occur during amoebiasis.<br />Foul smelling stools.<br />Loss of Appetite.<br />There will be pain over the liver, when pressure is applied just under the ribs on the right side.<br />Stomach Cramps.<br />Amoebic liver abscesses can also present as pyrexia of unknown origin. The abscess can sometimes rupture into the pleural, peritoneal or pericardial cavities.<br />You will feel weakness or tiredness, if you are suffering from amoebiasis.<br />Pain in the right shoulder could occur in chronic condition.<br />Nausea.<br />Treatment for Amoebiasis:<br />Metronidazole:- Metronidazole Amoebic dysentery is very effective for the treatment of amoebiasis. Complications, such as perforation of the intestinal wall or the presence of abscesses within the body's organs, require a special hospital treatment. <br />If you have bloody diarrhea, you can treat yourself with metronidazole, eg two 400mg tablets, three times a day for five days. This is the dose for adults who are neither pregnant nor breastfeeding.<br />Avoid Alcohol: - It is very important to avoid drinking alcohol during the treatment process of amoebiasis, otherwise you will not be able to get rid of disease easily. Try not to drink alcohol at all.<br />Home Remedies for Amoebiasis:<br />Some of the Common Home Remedies for Amoebiasis includes:-<br />Apricot:- The juice of apricot leaves should be extracted and applied over the infected area. It has beneficial results in the treatment of amoebiasis.<br />Neem:- Make a leaf paste with dried neem leaves and an equal quantity of turmeric powder mixed with mustard oil. This should be applied on the body and left for an hour or so. Then the person should bath. <br />Peepul:- The dried bark of a peepul tree can be powdered fine, strained through a fine sieve and used as a dusting powder on lesions of amoebiasis.<br />Drumstick:- Extract the juice from 400 - 500 gm of drumstick leaves. Mix with an equal amount of sesame seed oil, and boil till the water dries up. Cool and store. Apply daily over the infected parts. Both have strong anti-microbial properties.<br />http://www.thebeautytips.com/beauty/skin-disorders/amoebiasis.htm<br />You are here: Home / Pathophysiology / Pathophysiology of Amoebiasis<br />Pathophysiology of Amoebiasis<br />When cyst is swallowed, it passes through the stomach unharmed and shows no activity while in an acidic environment. When it reaches the alkaline medium of the intestine, the metacyst begins to move within the cyst wall, which rapidly weakens and tears. The quadrinucleate amoeba emerges and divides into amebulas that are swept down into the cecum. This is the first opportunity of the organism to colonize, and its success depends on one or more metacystic trophozoites making contact with the mucosa.<br />Mature cyst in the large intestines leaves the host in great numbers (the host remains asymptomatic). The cyst can remain viable and infective in moist and cool environment for at least 12 days, and in water for 30 days. The cysts are resistant to levels of chlorine normally used for water purification. They are rapidly killed by purification, desiccation and temperatures below 5 and above 40 degrees.<br />The metacystic trophozoites of their progenies reach the cecum and those that come in contact with the oral mucosa penetrate or invade the epithelium by lytic digestion.<br />The trophozoites burrow deeper with tendency to spread laterally or continue the lysis of cells until they reach the sub-mucosa forming flash-shape ulcers. There may be several points of penetration.<br />From the primary site of invasion, secondary lesions maybe produced at the lower level of the large intestine.<br />Progenies of the initial colonies are squeezed out to the lower portion of the bowel and thus, have the opportunity to invade and produce additional ulcers. Eventually, the whole colon may be involved.<br />E. histolytica has been demonstrated in practically every soft organ of the body.<br />Trophozoites which reach the muscularis mucosa frequently erode the lymphatics or walls of the mesenteric venules in the floor of the ulcers, and are carried to the intrahepatic portal vein.<br />If thrombi occur in the small branches of the portal veins, the trophozoites in thrombi cause lytic necrosis on the wall of the vessels and digest a pathway into the lobules.<br />The colonies increase in size and develop into abscess.<br />A typical liver abscess develops and consists of:<br />Central zone necrosis<br />Median zone of stoma only<br />An outer zone of normal tissue newly invaded by amoeba. Most amoebic abscess of the liver are in the right lobe.<br />Next to the liver, the organ which is the frequent site of extra-intestinal amoebiasis is the lungs. This commonly develops as an extension of the hepatic abscess.<br />Source:<br />Handbook of Common Communicable and Infectious Diseases 2006 Edition by Dionesia Mondejar-Navales, RN, MAEd<br />Amoebiasis (also known as spelt amebiasis) is an infection caused by the parasite entamoeba histolytica. It is usually contracted by ingesting water or food contaminated with amoebic cysts. Amoebiasis is an intestinal infection that may or may not be symptomatic. When symptoms are present it is generally known as invasive amoebiasis. People with amoebiasis have Entamoeba histolytica parasites in their faeces. The infection can spread when infected people do not dispose of their faeces in a sanitary manner or do not wash their hands properly after going to the toilet. It is usually transmitted by contamination of drinking water and foods with fecal matter, but it can also be transmitted indirectly through contact with dirty hands or objects. After infection, it may take from a few days up to two to four weeks before becoming ill. Some people with amebiasis may carry the parasite for weeks to years, often without symptoms. <br />Although rarely, amoebiasis can cause abscesses in the liver, lungs, and brain or even elsewhere in the body. Symptoms take from a few days to a few weeks to develop and manifest themselves, but usually it is about two to four weeks. Symptoms can range from mild diarrhoea to dysentery with blood and mucus. The blood comes from amoebae invading the lining of the intestine. Rarely, amoebiasis can cause an abscess in the liver. After infection, it may take a few days, several months or even years before you become ill but it is usually about two or four weeks. To trace the cause of the illness, it is necessary to know what you ate and drank and where you travelled in the weeks before you became ill. The parasite can cause ulcers to form in the intestine resulting in amoebic dysentery. Under these circumstances the diarrhoea becomes watery and bloody, the abdominal pain becomes more severe, and fever develops. <br />Causes of Amoebiasis <br />Amoebiasis is caused by a protozoa. Amoebiasis is commonly spread by water contaminated by faeces or from food served by contaminated hands. It can also spread to other organs like the liver, and brain by invading the venous system of the intestines. Asymptomatic carriers pass cysts in the faeces. Contaminated drinking water can also spread infection. The disease may also spread y oral-anal contact. <br />Common causes and risk factors of Amoebiasis: <br />Eating contaminated food. <br />Anal or directly from person to person contact. <br />Eating Non-Veg foods. <br />Unhygienic conditions and Poor sanitation areas. <br />Eating vegetables and fruits which have been contaminated by the harmful bacteria. <br />Signs and Symptoms of Amoebiasis <br />The most common symptoms of amoebiasis are diarrhoea, stomach cramps and fever. Rarely, amoebiasis can cause an abscess in the liver. Entamoeba histolytica parasites are only found in humans. After infection, it may take a few days, several months or even years before you become ill but it is usually about two or four weeks. <br />Sign and symptoms may include the following : <br />Abdominal cramps. <br />Nausea. <br />Painful passage of stools. <br />Loss of Weight. <br />Severe stomach pain. <br />Loss of Appetite. <br />Profuse diarrhoea. <br />Treatment for Amoebiasis <br />As a result two different sorts of drugs are needed to rid the body of the infection, one for each location. Metronidazole, or a related drug such a tinidazole, is used to destroy amebae that have invaded tissue. It is rapidly absorbed into the bloodstream and transported to the site of infection. Antibiotics, such as Metronidazole are necessary, and are given for 5 days for amoebic dysentery and for 10-14 days if there is a liver abcess or extraintestinal spread. Large abcesses in the liver may require drainage, using an ultrasound scan to localise the abcess accurately and position the drainage needle. <br />Treatment may include: <br />An anti-diarrhoeal medication may also be prescribed. Metronidazole can produce a metallic taste in the mouth and may give rise to nausea. <br />Make a leaf paste with dried neem leaves and an equal quantity of turmeric powder mixed with mustard oil. This should be applied on the body and left for an hour or so and then the person should bath. <br />If amoebiasis causes an abscess on your liver or other organs and the abscess does not respond to antibiotics, it may need to be drained surgically. <br />The juice of apricot leaves should be extracted and applied over the infected area. It has beneficial results in the treatment of amoebiasis. <br /> http://www.health-disease.org/skin-disorders/amoebiasis.htm<br />Amoebiasis / Amoebic Dysentery : Definition, Types, Causes, Symptoms, Diagnosis and general treatment of Amoebiasis/ Amoebic Dysentery <br />Amoebiasis is a common infection of the human gastrointestinal tract. It has a world wide distribution. It is.a major health problem in the whole of Chi,na, South East and West Asia and Latin America, especially Mexico. Globally it was estimated that, in 1981, 480 million people carried E. histolytica in their intestinal tract and approximately one-tenth of infected people, i.e., 48 million suffered from invasive amoebiasis. It is probable that invasive amoebiasis, accounts annually for 40,000 to 110,000 deaths in the world (3). Prevalence rates vary from as low as 2 per cent to 60 per cent or more in areas devoid of sanitation (4). In areas of high prevalance. Amoebiasis occurs in endemic forms as a result of high levels of transmission and constant reinfection. Epidemic water-born infections can occur if there is heavy contamination of drinking water supply. <br />Amoebiasis, a type of gastro, is a cause of diarrhoea among travellers to developing countries. It is caused by a parasite known as Entamoeba histolytica that infects the bowel. Amoebiasis is a parasitic infection of the large intestine. Amoebiasis can affect anyone, most commonly affects young to middle-aged adults. The term " amoebiasis" has been defined as the condition of harbouring the protozoan parasite Entamoeba histolytica with or without clinical manifestations. The symptomatic disease occurs in less than 10 per cent of infected individuals. <br />The symptomatic group has been further subdivided into intestinal and extraintestinal amoebiasis. Only a small percentage of those having intestinal infection will develop invasive amoebiasis. The intestinal disease varies from mild abdominal discomfort and diarrhoea to acute fulminating dysentery. Extraintestinal amoebiasis includes involvement of liver (liver abscess), Iungs, brain, spleen, skin, etc. Amoebiasis is a potentially lethal disease. It carries substantial morbidity and mortality. It is the simplest organism of the animal kingdom which belongs to the class of Rhizopoda, order of Amoebida, genus of Entamoeba and species of E.Histolytica. <br />Causes of Amoebiasis <br />Amoebiasis is causes by a parasite that can live in humans without making them ill, or it can make a person very sick by going into organs like the liver or heart. <br />The parasite only lives in humans, and can be spread from person to person. People can get the disease by eating food, or drinking water that contain the parasite. A person may also spread the disease by not washing their hands after going to the toilet or changing a nappy, and then handling food for other people. <br />Amoebiasis is caused by potentially pathogenic strains of E. histolytica. Recent studies have shown that E. histolytica can be differentiated into at least 18 zymodemes (a zymodeme is a population of organisms differing from similar populations in the electrophoretic mobilities of one or more enzymes). It has furthermore been shown that pathogenic strains are all from particular zymodemes; that non, invasive strains are from quite distinct zymodemes; that invasive strains can give rise to faecal cysts, and the organisms breed true . The iso-enzyme characteristics do not, however, determine why a particular zymodeme is able to invade. Isoenzyme electrophoretic mobility analysis have so far identified 7 potentially pathogenic and 11 non-pathogenic zymodems. <br />Forms of Amoebasis / Amoebic Dysentery <br />E. histolytica exists in two forms - vegetative (trophozoite) and cystic forms. Trophozoites dwell in the colon where they multiply and encyst. The cysts are excreted in stool. Ingested cysts release trophozoites which colonize the large intestine. Some trophozoites invade the bowel and cause ulceration, mainly in the caecum and ascending colon; than in the rectum and sigmoid. Some may enter a vein and reach the liver and other organs. <br />The trophozoites are short-lived outside the human body; they are not important in the transmission of the disease. In contrast the cysts are infective to man and remain viable and infective for several days in faeces, water, sewage and soil in the presence of moisture and low temperature. The cysts are not affected by chlorine in the amounts normally used in water purification, but they are readily killed if dried, heated (to about' 55 deg C) or frozen. <br />How its spread <br />Amoebiasis may occur at any age. There is no sex or racial difference in the occurrence of the disease. Amoebiasis is frequently a household infection. When an individual in a family is infected, others in the family may a Iso be affected. Specific a ntiamoebic antibodies are produced when tissue invasion takes place. There is strong evidence that cell-mediated immunity plays an important part in controlling the recurrence of invasive amoebiasis . Amoebiasis occurs when the parasites are taken in by mouth. People with amoebiasis have Entamoeba hisolytica parasites in their faeces. The infection can spread when infected people do not dispose of their faeces in a sanitary manner or do not wash their hands properly after going to the toilet. Contaminated hands can then spread the parasites to food that may be eaten by other people and surfaces that may be touched by other people. Hands can also become contaminated when changing the nappies of an infected infant. Amoebiasis can also be spread by: <br />Faecal-oral route. This may readily take place through intake of contaminated water or food. Epidemic water-borne infections can occur if there is heavy contamination of drinking water supply. Vegetables, especially those eaten raw, from fields irrigated with sewage polluted water can readily convey infection. Viable cysts have been found on the hands.and under finger nails. This may lead to direct hand to mouth transmission. <br />Sexual transmission by oral-rectal contact is also recognized, especially among male homosexuals. (Hi) Vectors such as flies, cockroaches and rodents are capable of carrying cysts and contaminating food and drink. <br />Symptoms of Amoebiasis / Amoebic Dysentery <br />Most of the cases may not have any symptoms at all and function only as carriers and also function as spreaders, polluting the areas wherever they go. The disease symptoms usually start after a period of 7-15 days of infection which is called the incubation period. The symptoms are in two forms: <br />1. By burrowing the intestines and making ulcers, which bleed and cause anaemia or other diseases due to added infection 2. Absorbing the food from the host or letting out toxic substances in the intestines <br />Usually symptoms start with diarrhoea (watery stools) and abdominal pain (mostly in right hypochondrium) <br />Poor appetite or fear of food due to abdominal pain and loose stools <br />Later, with increased intensity of the infection, fever, nausea and bloody stools i.e. characteristic amoebic dysentery with slimy mucous occurs and complicate the condition <br />In due course, the patient loses weight and stamina <br />Sometimes allergic reactions can occur throughout the body, due to release of toxic substances or dead parasites inside the intestines. <br />Diagnosis of Amoebiasis / Amoebic Dysentery <br />Stool examination - Microscopic examination for identifying demonstrable E.H cysts or trophozoites in stool samples is the most confirmative method for diagnosis. Trophozoites survive only for a few hours, so the diagnosis mostly goes with the presence of cysts. But fresh warm faeces always show trophozoites. The cysts are identified by their spherical nature with chromatin bars and nucleus. They are noticed as brownish eggs when stained with iodine. Biopsy also can point out E.H cysts or trophozoites. Culture of the stool also can guide us for diagnosis. Blood tests may suggest infection which may be indicated as leucocytosis (increased level of white blood cells), also it can indicate whether any damage to the liver has occurred or not. Ultrasound scan - it should be performed when a liver abscess is suspected. <br />Treatment of Amoebiasis / Amoebic Dysentery <br />Symptomatic cases: At the health centre level, symptomatic cases can be treated effectively with metronidazole orally and the clinical response in 48 hours may confirm the suspected diagnosis. The dose is 30mg/kg/day, divided into 3 doses after meals, for 8-10 days. Tinidazole can be used instead of metronidazole. Suspected cases of liver abscess should be referred to the nearest hospital. (ii) Asymptomatic infections: In an endemic area, the concensus is not to treat such persons because the probability of reinfection is very high (3). They may however be treated, if the carrie is a food handler. In non-endemic areas they are always likely to h treated. They should be treated with oral diiodohyroxyquin, 650 ml t.d.s. (adults) or 30-40 mg/kg/day (children) for 20 days, or ore diloxanide furoate, 500 mg t.d.s. for 10 days (adults). <br />At present there is no acceptable chemoprophylaxis for amoebiasis. Mass examination and treatment cannot be considered solution for the control of amoebiasis. <br /> <br /> <br /> <br /> <br />

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