about ameobiasis

2.  A disease associated with the way a person or group of
people lives. Lifestyle diseases include
atherosclerosis, heart disease, and stroke; obesity and
type 2 diabetes; and diseases associated
with smoking and alcohol and drug abuse. Regular
physical activity helps prevent obesity, heart disease,
hypertension, diabetes, colon cancer, and premature
mortality.

3.  Amoebiasis, also known amoebic dysentery, is an infection caused by any
of the amoebas of the Entamoeba group.
 Symptoms are most common during infection by
Entamoeba histolytica.
 Amoebiasis can be present with no, mild, or severe symptoms.
 Symptoms may include abdominal pain, diarrhea, or bloody diarrhea.
Complications can include inflammation of the colon with tissue
death or perforation, which may result in peritonitis.
 People affected may develop anemia due to loss of blood.

4.  Amoebiasis was first described by Lösh in 1875, in northern Russia.
 The most dramatic incident in the US was the Chicago World's Fair outbreak in
1933 caused by contaminated drinking water.
 There were more than a thousand cases, with 98 deaths.
 It has been known since 1897 that at least one non-disease-causing species of
Entamoeba existed (Entamoeba coli).
 Joel Connolly of the Chicago Bureau of Sanitary Engineering brought the outbreak
to an end when he found that defective plumbing permitted sewage to contaminate
drinking water.
 The Nicobarese people have attested to the medicinal properties found
in Glochidion calocarpum, a plant common to India, saying that its bark and seed
are most effective in curing abdominal disorders associated with amoebiasis.

6. NORMAL LIVER LIVER WITH AMOEBIASIS

8.  Most infected people, about 90%, are asymptomatic.
 Infections can sometimes last for years. 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 diarrhea to severe
dysentery with blood and mucus.
 The blood comes from lesions formed by the amoebae invading the lining
of the large intestine. In about 10% of invasive cases the amoebae enter the
bloodstream and may travel to other organs in the body.
 In asymptomatic infections the amoeba lives by eating and digesting
bacteria and food particles in the gut, a part of the gastrointestinal tract.
 It does not usually come in contact with the intestine itself due to the
protective layer of mucus that lines the gut.
Cont…….

9.  Disease occurs when amoeba comes in contact with
the cells lining the intestine.
 It then secretes the same substances it uses to digest
bacteria, which include enzymes that destroy cell
membranes and proteins.
 This process can lead to penetration and digestion of
human tissues, resulting first in flask-shaped ulcers in
the intestine.
 Entamoeba histolytica ingests the destroyed cells
by phagocytosis and is often seen with red blood
cells (a process known as erythrophagocytosis) inside
when viewed in stool samples.

11.  With colonoscopy it is possible to detect small ulcers of
between 3–5mm, but diagnosis may be difficult as
the mucous membrane between these areas can look
either healthy or inflamed.
 Asymptomatic human infections are usually diagnosed
by finding cysts shed in the stool.
 Various flotation or sedimentation procedures have
been developed to recover the cysts from fecal matter
and stains help to visualize the isolated cysts for
microscopic examination.
 Since cysts are not shed constantly, a minimum of three
stools are examined. In symptomatic infections, the
motile form (the trophozoite) is often seen in fresh
feces.

12.  Serological tests exist, and most infected individuals (with
symptoms or not) test positive for the presence of
antibodies.
 The levels of antibody are much higher in individuals
with liver abscesses.
 Serology only becomes positive about two weeks after
infection.
 More recent developments include a kit that detects the
presence of amoeba proteins in the feces, and another that
detects ameba DNA in feces.
 These tests are not in widespread use due to their expense.

16.  To help prevent the spread of amoebiasis around the home :
 Wash hands thoroughly with soap and hot running water for at
least 10 seconds after using the toilet or changing a baby's diaper,
and before handling food.
 Clean bathrooms and toilets often; pay particular attention
to toilet seats and taps.
 Avoid sharing towels or face washers.
 To help prevent infection:
 Avoid raw vegetables when in endemic areas, as they may have
been fertilized using human feces.
 Boil water or treat with iodine tablets.
 Avoid eating street foods especially in public places where others
are sharing sauces in one container

17.  A 24-year-old male patient presented to the surgical
emergency ward with history of high-grade fever with chills
and rigors of 10-day duration, along with non-radiating pain
in the right hypochondrium.
 There was history of falling from 10 feet high 5 days prior
to the onset of fever. There was also a history of yellowish
discolouration of the eyes for 5 days and disorientation for
1 day.
 On examination, he was febrile, with a pulse rate of 120
beats/minute, and was normotensive.
 He was drowsy, disoriented, and deeply jaundiced. On
abdominal examination, his liver was enlarged, with a span
of 20 cm, and there was intercostal tenderness over the
lower spaces on the right side.
 There was no free fluid in the abdomen.

18.  On chest examination, there was bilateral equal air
entry.
 Upon investigation, haemoglobin was 11 g/dL, with a
total leukocyte count of 13 000 cells/mm3 (normal
range is 4000–11 000 cells/mm3).

19.  Liver function tests revealed total serum bilirubin of 20
mg/dL, with direct bilirubin of 15 mg/dL, serum
glutamic-oxaloacetic transaminase (SGOT) of 324 IU/L
(normal level is less than 40 IU/L), serum glutamic–
pyruvic transaminase (SGPT) of 340 IU/L (normal
level is less than 40 IU/L), and alkaline phosphatase of
90 kAU/L (normal range is 3–13 kAU/L).
 The patient tested positive for amoebic serology by
ELISA.

20.  A computed tomographic scan showed a large mass in
the right lobe of the liver with central hyperintense
contents surrounded by a thick irregular hypointense
rim The patient was started on anti-amoebic therapy
(ciprofloxacin and metronidazole),
vitamin K, and
intravenous fluids.
 His condition deteriorated over the next 24 hours, and
signs of septicaemia persisted.

22.  The patient was started on anti-amoebic therapy
(ciprofloxacin and metronidazole), vitamin K, and
intravenous fluids.
 The patient was discharged in good condition.
 Subsequent follow-up for 3 months and repeat
ultrasound performed at the end of 3 months showed no
residual abscess.