Tuberculosis (TB) is a life threatening disease which can virtually affect any organ system.
Abdominal tuberculosis is a most common type of extra-pulmonary tuberculosis, comprising of tuberculosis of gastrointestinal tract, peritoneum, omentum, mysentery and its lymph nodes and other abdominal organs such as liver, spleen and pancreas.
Abdominal tuberculosis can occur primarily or it can be secondary to a tubercular focus elsewhere in the body.
Gastrointestinal tuberculosis occurring due to ingestion of milk or food infected with Mycobacterium bovis can result in primary intestinal tuberculosis, but it is now-a days rare.
Firstly, the tubercle bacilli may enter the intestinal tract through the ingestion of infected milk or sputum. The mucosal layer of the GI tract can be infected with the bacilli with formation of epithelioid tubercles in the lymphoid tissue of the submucosa.
After 2-4 weeks, caseous necrosis of the tubercles leads to ulceration of the overlying mucosa which can later spread into the deeper layers and into the adjacent lymph nodes and into peritoneum.
Tuberculosis (TB) is a life threatening disease which can virtually affect any organ system.
Abdominal tuberculosis is a most common type of extra-pulmonary tuberculosis, comprising of tuberculosis of gastrointestinal tract, peritoneum, omentum, mysentery and its lymph nodes and other abdominal organs such as liver, spleen and pancreas.
Abdominal tuberculosis can occur primarily or it can be secondary to a tubercular focus elsewhere in the body.
Gastrointestinal tuberculosis occurring due to ingestion of milk or food infected with Mycobacterium bovis can result in primary intestinal tuberculosis, but it is now-a days rare.
Firstly, the tubercle bacilli may enter the intestinal tract through the ingestion of infected milk or sputum. The mucosal layer of the GI tract can be infected with the bacilli with formation of epithelioid tubercles in the lymphoid tissue of the submucosa.
After 2-4 weeks, caseous necrosis of the tubercles leads to ulceration of the overlying mucosa which can later spread into the deeper layers and into the adjacent lymph nodes and into peritoneum.
Escherichia coli species are components of the
Normal animal and human colonic flora;
Flora of a variety of environmental habitats, including long-term care facilities (LTCFs) and hospitals.
E.coli are the cause of most nosocomial infections.
Acute infectious diarrhea
Seminar Prepared by :-
Mohammed Musa
Mohammed Saadi
Hussein Jassam
Mahmoud Ahmed
Meran Salih
Internal Medicine
College of Medicine - University of Kirkuk
Amoebiasis, also known amoebic dysentery, is an infection caused by any of the amobae 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.
shigellosis presentation , communicable diseases lecture, community medicine master , university of Khartoum
contains basic information about the disease, its clinical features and treatment
Escherichia coli species are components of the
Normal animal and human colonic flora;
Flora of a variety of environmental habitats, including long-term care facilities (LTCFs) and hospitals.
E.coli are the cause of most nosocomial infections.
Acute infectious diarrhea
Seminar Prepared by :-
Mohammed Musa
Mohammed Saadi
Hussein Jassam
Mahmoud Ahmed
Meran Salih
Internal Medicine
College of Medicine - University of Kirkuk
Amoebiasis, also known amoebic dysentery, is an infection caused by any of the amobae 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.
shigellosis presentation , communicable diseases lecture, community medicine master , university of Khartoum
contains basic information about the disease, its clinical features and treatment
Gastroenteritis
One of the primary concerns related to gastrointestinal (GI)infection, regardless of the cause, is dehydration, which is the second leading cause of worldwide morbidity and mortality.
Worldwide, dehydration is especially problematic for children younger than age 5.
However, the highest rate of death occurs among the elderly.
Rehydration is the foundation of therapy for GI infections, and oral rehydration therapy (ORT) is usually preferred.
Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract—the stomach and intestine.
Diarrhea is defined as the production of stool of abnormally loose consistency, usually associated with excessive frequency of defecation and excessive stool output.
Acute Diarrhea lasts 14 days or less.
Persistent Diarrhea lasts more than 14 days.
Chronic Diarrhea lasts more than 1 month.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Dysentery
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Dysenteries
Dysenteryreferstothe presence of grosslyvisible bloodinthe stoolsand diarrhoeawith
abdominal cramps,tenesmusandpassage of mucusinthe stools isconsequence of infectionof
the colon by eitherbacteriaoramoeba.
There are 2 main formsof dysenteries—bacillaryandamoebic.
Bacillary Dysentery (Shigellosis)
INTRODUCTION
Bacillarydysenteryismuch more commoninchildrenthanamebicdysentery.
The bacteriacausingbloodydiarrheaare Shigellaspecies(S.dysenteriae,S.flexneri,S.boydii and
S. sonnei.),enteroinvasive andenterohemorrhagicE.coli,SalmonellaandCampylobacterjejuni.
S. flexneri isthe commonestorganismreportedindevelopingcountriesand
S. dysenteriaeisassociatedwithepidemicsof dysentery.
TRANSMISSION
Infectionoccursbyfoeco-oral route andisseenwithpoorpersonal hygiene,indensely populated
areas,and withcontaminatedfoodandwater.The commonhouseflyplaysa role inspreadof
infection.
CLINICAL MANIFESTATION / CLINICAL FEATURES / SIGN & SYMPTOMS
A childwithbacillarydysenterypresentswithfeveranddiarrhea.Diarrheamaybe wateryto start
with,butthenshowsmucusand bloodmixedwithstools.
There istenesmus,whichreferstoineffectual defecationalongwithstrainingandsuprapubic
discomfort.
Grossly, earlyintestinal lesionsappearassmall areasof elevationonthe mucosal surface.In
advancedcases,typical flask-shapedulcershavingnarrow neckandbroadbase are seen.They
are more conspicuousinthe caecum,rectumandinthe flexures (Fig. 1).
Microscopically, the ulceratedareashowschronicinflammatoryreactionconsistingof
lymphocytes,plasmacells,macrophagesandeosinophils.The trophozoitesof Entamoeba are
seeninthe inflammatoryexudate andare concentratedatthe advancingmarginof the lesion.
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Intestinal amoebaecharacteristicallyhave ingestedredcellsintheircytoplasm.Oedemaand
vascularcongestionare presentinthe areasurroundingthe ulcers.
A. The luminal surface shows multiple
ulcers some of which are deep and are
flask-shaped with narrow neck and
broad base (arrow) containing necrotic
tissue and undermined margins.
B. Trophozoites of Entamoeba histolytica
are seen at the margin of ulcer (arrow).
COMPLICATION
The illnessmaybe complicatedbydehydration,dyselectrolytemia,hemolyticuremicsyndrome,
convulsions,toxicmegacolon, intestinal haemorrhage,perforation&stenosis, rectal prolapse,
polyarthritisandiridocyclitis and,veryrarely,Shigellaencephalopathy.
TREATMENT
Administrationof ORS,continuationof oral diet,zincsupplementation andantibiotics are the
componentsof treatment.
Stool culture andsensitivityshouldbe sentfor before startingempirical antibiotics.Antimicrobial
agentsare the mainstayof therapyof all cases of shigellosis.Basedonsafety,low costand
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efficacy, ciprofloxacin(15mg/kg/day intwodivideddosesfor3days) has beenrecommendedby
WorldHealth Organization(WHO) asthe firstline antibioticforshigellosis.
However,antimicrobial resistancetofluoroquinoloneshadincreasedsignificantlyfrom2002 to
2011 and onlyceftriaxonehasbeenshowntobe uniformlyeffective.Keepingthisinmind,
intravenous ceftriaxone (50-100 mg/kg/dayfor 3-5 days) shouldbe the firstline of treatmentin
a sick child.
In a stable child,eitherciprofloxacinororal cefixime maybe given,butthe patientshouldbe
monitoredforclinical improvementwithin48hr ( decrease infever,stool frequencyandbloodin
stools).
If no improvementisseenat48 hr, antibioticsshouldbe changedappropriately.
Oral Azithromycin(10mg/kg/dayfor3 days) can be usedforshigellosisbutthe experience is
limited.
Amoebic Dysentery (Amebiasis)
INTRODUCTION
Amebiasis is defined as infection with Entamoeba histolytica.
Amebic dysentery is less common among children.
The onset is insidious.
Tinidazole or metronidazole is the drug of choice.
Any young child presenting with blood in stools and persistent abdominal pain should be
suspected to have intussusception and evaluated accordingly.
Clinical features of amebiasis range from asymptomatic colonization to amebic dysentery
and invasive extraintestinal amebiasis, occurring most commonly as liver abscess.
It is more prevalent in the tropical countries and primarily affects the large intestine.
Infection occurs from ingestion of cyst form of the parasite. The cyst wall is dissolved in
the small intestine from where the liberated amoebaepass into the large intestine.
Here, they invade the epithelium of the mucosa, reach the submucosa and produce the
characteristic flask-shaped ulcers.
EPIDEMIOLOGY
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E. histolytica is thought to infect 10% of the world's population and 2-55% Indians.
However, these may be overestimates, because two morphologically identical,
genetically distinct but apparently nonpathogenic Entamoeba species, namely E. dispar
and E. moshkovskii, cause most asymptomatic cases.
Amebic dysentery and extraintestinal amebiasis is associatedwith a high rates of
morbidity and mortality. It is less common in children, accounting for less than 3% of
diarrhea in children below 5 yr.
ETIOPATHOGENESIS
An ingested cyst divides in the small intestine to form 8 trophozoites that colonize the
mucosa of the large intestine. Trophozoites cause tissue invasion and destruction with
little or no local inflammation, resulting in characteristic flask shaped ulcers in cecum,
transverse colon and sigmoid colon.
Extraintestinal complications occur when trophozoites invade the bloodstream and
migrate through the portal circulation to lodge, most commonly, in the liver.
Amebic liver abscess is usually single (95%) and more frequently involves the
posterosuperior part of right lobe of the liver.
The abscess may regress, rupture or disseminate; transdiaphragmatic rupture may cause
amebic empyema and pulmonary amebiasis.
Rare complications include amebic involvement of peritoneum, pericardium, pleura,
lungs, brain, genitourinary system and skin.
CLINICAL FEATURES
Asymptomatic cyst passage is the most common manifestation of E. histolytica.
In most cases the infection resolves spontaneously; uncommonly, amebic dysentery and
other invasive manifestations may occur later.
After an incubation period varying from weeks to months, about 10% individuals
colonized with E. histolytica develop symptomatic disease.
Amebic colitis presents as abdominal pain or tenderness (in 80%), with watery, bloody or
mucous diarrhea. Some may have only intermittent diarrhea alternating with
constipation. Fever is unusual.
Occasionally, fulminant amebic colitis may occur, with profuse bloody diarrhea, fever,
widespread abdominal pain, diffuse tenderness and pronounced leukocytosis. Toxic
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megacolon, ameboma, cutaneous amebiasis and rectovaginal fistulae can occur as
complications of intestinal amebiasis.
COMPLICATIONS
Complications of intestinal amoebic ulcers (flask shape) are listed below.
1. Amoebic liver abscess
2. Amoebic hepatitis
3. Intestinal perforation
4. Intestinal haemorrhage
5. Formation of amoeboma which is a tumour-like mass.
Amebic liver abscess, seen in about 1 % of infected individuals, may occur months to yr
after infection.
While some individuals may have concurrent amebic colitis, more commonly, there are
no bowel symptoms.
The child usually presents with fever with chills and rigors and right upper quadrant pain
of acute onset (<10 days).
Examination reveals toxicappearance, right upper quadrant tenderness and
hepatomegaly; jaundiceis unusual (10- 15%).
Cough along with dullness or crepitations in the right lung base may be present.
Complications include rupture into the pleura pericardium and superinfection with
bacteria.
DIAGNOSIS
Diagnosis of amebic colitis is established by demonstration of motile trophozoites by
direct microscopic examination of fresh fecal sample.
At least 3 stool specimens taken on consecutive days should be examined because the
test has poor sensitivity ( <60%; -90% with 3 fresh samples).
Stool contains plenty of erythrocytes but few leukocytes, unlike bacillary dysentery,
where leukocytes are plentiful.
Presence of ingested erythrocytes within trophozoites is pathognomonic for E.
histolytica. Presence of cysts of E. histolytica in stool samples is of no clinical significance
and should not be treated.
Serological tests are routinelyemployedfordiagnosisof extraintestinal disease with E.
histolyticaespeciallyfordifferentiatingamebicfrompyogenicliverabscess.
They are positive in70-80% patientswithinvasive diseaseatpresentationandin>90% cases
beyondfirstweekof symptoms.
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IgG antibodies persistforyrafterE. histolyticainfection,whereasthe IgMantibodiesindicate
presentorcurrent infection.
Commonlyusedserologictestsinclinical practice are ELISA,IHA andIFA.Serological response as
detectedby ELISA becomesnegative6-12 monthsafterinfection.
The IHA testis simple toperformandhasbeenshown tobe highlyspecific(-99%) andsensitive.
The test maystay positive foraslongas 10 yr followingcompleterecovery,limitingitsutilityin
endemicareas.
The IFA testisrapid,reliable,reproducibleand helpstodifferentiate amebicliverabscessfrom
othernonamebicetiologies.
In case of a liverabscess chestradiographshowselevated diaphragmandpleural reactionon
the right side.
Ultrasound,CT,MRI, or isotope scan can localize the abscess inmostcases. Leukocytosis
withouteosinophilia, mildanemia,raisedalkaline phosphatase,andahigherythrocyte
sedimentationrate (ESR) are commonlaboratoryfindingsinthese patients.
TREATMENT
The practice of givingantiamoebicdrugsforall children presentingwithdiarrheashouldbe
stronglydiscouraged since amebiasisisrelativelyuncommoninyoungchildren. Metronidazoleis
the drug of choice fortreatingamebic colitis(Table 10.14).
Alternativesinclude tinidazole, orindazoleandsecnidazole.Since metronidazoledoesnot destroy
the cysts,a luminal agent(paromomycin, iodoquinol,ordiloxanidefuroate)shouldbe usedto
eradicate colonization.
Whenpossible,fulminantamebiccolitis,evenwithperforation,ismanaged conservatively, with
the additionof antibioticstodeal withbowelflora. Mostamebicliverabscesses,evenlarge ones,
can be curedwithoutdrainage.Mostpatientsshow a response totreatment(reducedfeverand
abdominal pain) within 72-96 hr.
Individuals withamebicliverabscessshould alsoreceive aluminal agenttoeliminateintestinal
colonization.TherapeuticaspirationguidedbyCTinthe treatmentof uncomplicatedamebicliver
abscessis controversial.
Large amebicliverabscesses(>300 ml) may benefitfromaspirationwithdecrease indurationof
hospital stayandfasterclinical improvementrecovery whencomparedtothose managed
medicallyalone.
Abscesscavityresolvesslowlyoveraperiodof several months.
Aspirationisreservedforindividualsinwhom diagnosisisuncertain(where pyogenicabscessor
bacterial superinfectionisaconcern),those whohave not respondedtometronidazoletherapy
(persistentfeverorabdominal painafter4 daysof treatment),individuals withlarge leftlobe
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DUMC
abscesses(because of the riskof rupture intothe pericardium),size more than 8-10 cm
(suggestingimpendingrupture) andseverelyill patientswithan acceleratedclinical course and
large abscesses.
Aspiration, percutaneous catheterdrainage,orboth,improve outcomes inthe treatmentof
amebicempyemaafterliverabscessrupture,andintreatmentof amebicpericarditis or
peritonitis.
Giardiasis
INTRODUCTION
Giardiasis, caused by Giardia lamblia (also known as G. intestinalis or G. duodena/is), is a
major cause of diarrhea in children and in travelers.
EPIDEMIOLOGY
The infection is endemic in developing countries with poor sanitation. Individuals with
malnutrition, humoral immunodeficiencies and cystic fibrosis are particularly susceptible.
Children appear to be more severely affected than adults.
ETIOPATHOGENESIS
Giardia exists in two stages, cysts and trophozoites. Outside the human body it exists in
the form of cysts.
Cysts are hardy, capable of surviving in cool, moist environments for up to 2 months and
in water that has been routinely chlorinated, but are destroyed by boiling for 10 min.
Transmission of infection is through cysts, which may be ingested in contaminated water
or food or spread by direct person-to-person contact.
Ingestion of 10-100 cysts is sufficient for causing infection.
Low pH of the duodenum facilitates excystation and release of trophozoites.
Trophozoites colonizethe duodenum and proximal jejunum of the host, where they
attach to the intestinal brush border.
It is believed that the infection causes diarrhea via a combination of intestinal
malabsorption and hypersecretion.
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These effects cause malabsorption and maldigestion and in addition, may facilitate the
development of chronic enteric disorders, including inflammatory bowel disease and
irritable bowel syndrome.
CLINICAL FEATURES
The incubation period after ingestion of cysts is 1-2 weeks.
Most infections in both children and adults are asymptomatic.
Symptomatic infections are more common in children than in adults and usually take the
form of acute diarrhea with sudden onset of explosive, watery, foul smelling stools, along
with nausea and anorexia; others may also have abdominal distension, flatulence,
epigastric cramps and mild fever.
There is no blood or mucus in stools.
The illness may last 3--4 days and is usually self limiting in normal immunocompetent
children.
Variable degree of malabsorption may occur.
Some patients may have a protracted course, with persistent or recurrent mild to
moderate symptoms such as brief episodes of loose foul smelling stools alternating with
constipation.
Persistent diarrhea may be seen in 30-50% cases.
A few children may develop chronic diarrhea, lactose and fat malabsorption and failure to
thrive.
DIAGNOSIS
Diagnosis of giardiasis is established by microscopic examination of at least 3 fresh
specimens of stools collected on alternate days. There is no blood or leukocytes in stools.
Enzyme immunoassay (EIA) and direct fluorescent antibody test for Giardia antigens in
stools have been reported to have better sensitivity and require less expertise than
traditional microscopy.
Where diagnosis is strongly suspected, duodenal aspirate or biopsy may yield high
concentration of Giardia when fresh wet mount is examined for trophozoites.
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DUMC
Where duodenal aspirate is negative, intestinal biopsy may be considered in presence of
features like lactose malabsorption or abnormal radiographic findings (edema or
segmentation in small intestine), or a suggestive setting like absent secretory IgA or
hypogammaglobulinemia.
TREATMENT
All symptomatic cases-acute and persistent diarrhea, failure to thrive and malabsorption
syndrome-require drug treatment.
Asymptomatic cyst carriers are not treated except in specific situations like for outbreak
control or for prevention of spread from toddlers to immunocompromised family
members.
Treatment options are listed in Table 10.15.
TABLE 10.15: AGENTS FOR TREATMENT OF GIARDIASIS
Drug Dosage
Drugs of choice
Tinidazole
50 mg/kg (maximum 2 g) orally, single dose
Metronidazole
5-10 mg/kg (maximum 250 mg) orally q 8 hr for 7 days
Nitazoxanide
Age 1-3 yr: 100 mg orally q 12 hr for 3 days
Age 4-11 yr: 200 mg orally q 12 hr for 3 days
Age >11 yr: 500 mg orally q 12 hr for 3 days
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DUMC
Alternative agents (drugs)
Albendazole
10-15 mg/kg (maximum 400 mg) orally once daily for 5 days
Mebendazole
200 mg orally q 8 hr for 5 days
Paromomycin*
10 mg/kg orally q 8 hr for 5-10 days
Furazolidone
1.5 mg/kg (maximum 100 mg) orally q 6 hr for 7-10 days
Quinacrine
2 mg/kg (maximum 100 mg) orally q 8 hrfor 5 days
*Has poor intestinal absorption; useful in treating giardiasis during Pregnancy "Monoamineoxidase inhibitor;
significant food and drug interactionsif used for >5 days