Amibiasis
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Amibiasis

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Amibiasis Amibiasis Presentation Transcript

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