• 5 years old boy admitted through
GIT clinic with :
• Hx of on/off Abdominal pain.
• bloody diarrhea and fever for
last 8 month.
• There was 5 attacks . Each with
bloody stool with mucus and
• 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.
• 1st attack occurred after swallwing
water from swimming pool.
• No vomiting.
• No jundice.
• No arthralgia.
• No rash.
• No travel.
• 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.
Family history :
Wt: 16 kg 5th
Ht:112 cm 50th
musculoskeletal : within normal.
• 5 years old boy Hx recurrent
Amebiasis (bloody diarrhea,
tenesmus ,abdominal pain)
• Chronic amibiasis.
Acute on top of chronic.
• Entamoeba histolytica infection is
one of the significantly common
encountered in Saudi Arabia.
• Approximately 10% of the world's
population is infected by
• 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 .
• true prevalence of E. histolytica
infection is not known due to
inability to differentiate.
• Amebiasis is highly endemic in
Africa, Latin America, India, and
• In KSA no data.
• 3rd leading parasitic cause of
• direct fecal-oral contact are the
most common means of infection.
• Infection is established by
ingestion of parasite cysts
• colicky abdominal pains
• Diarrhea .bloody and mucoid
• fever . in only ⅓ of patients. But
may indicate liver involvement.
• CBC: anemia and slight
• LFT: high liver enzymes mainly
ALK if liver involved.
• 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
• negative in >50% of patients with
documented amebic liver abscess.
• ELISA : detection antigens in
stool by enzyme-linked
• PCR from stool.
• Serology :serum antiamebic
• Sigmoidoscopy and/or
colonoscopy: can be performed
either to make the diagnosis of
amebiasis or to exclude other
causes of the patients'
• Ultrasonography, CT, or MRI : for