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 fo...
History
• There was 5 attacks . Each with
bloody stool with mucus and
documented fever.
• Abdominal pain on/off with or
wi...
History
• 1st attack occurred after swallwing
water from swimming pool.
• No vomiting.
• No jundice.
• No arthralgia.
• No...
History
• Admitted twice in MCH due to
E.histolitica in stool .
• Received 5 courses of
metronidazole for 10 days.
• Seen ...
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
musc...
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...
ETIOLOGY
Entamoeba histolytica.
Entamoeba dispar.
E. moshkovskii.
E. coli.
E. hartmanni.
E. gingivalis.
E. polecki.

Asymp...
ETIOLOGY
• Many patients previously
described as asymptomatic
carriers of E. histolytica based on
microscopy findings were...
EPIDEMIOLOGY
• true prevalence of E. histolytica
infection is not known due to
inability to differentiate.
• Amebiasis is ...
EPIDEMIOLOGY
• 3rd leading parasitic cause of
death worldwide
• direct fecal-oral contact are the
most common means of inf...
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...
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 9...
investigation
• ELISA : detection antigens in
stool by enzyme-linked
immunosorbent assays.
• PCR from stool.
• Serology :s...
investigation
• Sigmoidoscopy and/or
colonoscopy: can be performed
either to make the diagnosis of
amebiasis or to exclude...
differential diagnosis
• bacterial colitis (Shigella,
Salmonella, Escherichia coli,
Campylobacter, Yersinia,
Clostridium d...
COMPLICATIONS
•
•
•
•
•

necrotizing colitis.
toxic megacolon.
extraintestinal extension.
local perforation and peritoniti...
TREATMENT
Invasive disease
metronidazole
Then Paromomycin
followed
by
Tinidazole
Diloxanide
furoate
Iodoquinol
ASYMPTOMATI...
TREATMENT
• E. histolytica infection is
asymptomatic in about 90% of
persons, but it has the potential to
become invasive ...
PREVENTION
•
•
•
•

Hand washing.
Clean bathrooms and toilets often.
Avoid sharing towels.
Avoid raw vegetables when in
en...
Page 33
THANK
YOU
Page 34
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Amibiasis

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Amibiasis

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

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