TROPICAL DISEASE 4

AMEBIASIS

COMPLICATIONS & DIAGNOSIS

4. Haemorrhage :
Amebic ulceration is rarely complicated by bleeding which may
often be severe and may require blood transfusion.Surgery may be
required.

5. Appendicitis:
Amebic ulcers have been demonstrated in appendices removed at
surgery; they are often associated with amebic colitis in other
parts of the bowel and perforation of the appendix can occur.

1.4 DIAGNOSIS
* Stool examination is a rapid and useful method.
However, demonstration of an amebic form does not necessarily
indicate that the symptoms are related.

* A sigmoidoscopy, and latex agglutination are the most
reliable tests.
* In symptomatic intestinal amebiasis, 70-90% are positive.
In the commensal state a lower percentage are positive.
However, circulating antibodies may persist for years.
Therefore, in endemic areas, a positive result does not
mean a currently active infection.
* Colonscopy may also be necessary for the diagnosis.
Treatment
* Therapeutic drug trial of an antiamebic drugs may be
necessary.
Most drugs that eliminate cysts or trophozoites from the gut do
not destroy tissue invading trophozoites.
Thus it is logical to combine a luminal amebicide and a tissue amebicide.
Where surgical complication is suspected, therapy should be started
without awaiting confirmation of diagnosis with parenteral
metronidozole, or in young patients with emetine and surgery
carried out urgently.

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TROPICAL DESEASES 3

AMEBIASIS

1.2 CLINICAL FEATURES

Intestinal Amebiasis:
- Mild diarrhea, with periodic spontaneous exacerbations,
there are remissions,and running a chronic course is the most common
presentation.
* The stools are loose, laden with mucus and
* Tenesmus is a prominent symptom.
* Systemic symptoms are not prominent.
* In tropical countries acute dysentery with bloody
diarrhoea, dehydration, systemic symptoms and electrolyte
losses may occur.
* Right lower quadrant tenderness may simulate acute
appendicitis.
* There may also be tenderness along the line of the colon
which may also be palpable along its length.

1.3 COMPLICATIONS

1. Perforation with peritonitis : Perforation may result from
transmural necrosis of the affected bowel, the peritoneal
cavity is grossly contaminated with feaces.
* The highest incidence of perforation in intestinal
amebiasis is seen in women during the puerperium.
* Peritonitis may also occur in the absence of perforation
by spread of infection through friable and edematous
wall of the bowel.
* Occasionally localisation of the perforation produces
a paracolic abscess and
* Rarely, an internal fistula is formed.

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TROPICAL DISEASE 2

1.1 PATHOLOGY

· Intestinal:
The trophozoites of E.histolytica have an
invasive capability
The parasite penetrates the depths of the colonic crypts
at separate locations.Usually unaccompanied by
inflammatory reaction.
With progressive involvement penetration of the
muscularis mucosa occurs.
Overlying surface epithelium (mucosa) is then breached
and typically circumscribed flask shaped ulcers are
formed which eventually become confluent and involve the
muscularis
The cecum is the most common site of involvement followed
by ascending colon and the recto-sigmoid.
On occasion, tissue reaction includes an exuberant,
fibroblastic and lymphocytic response known as ameboma.
Such lesions occur in 1-5% of cases of amoebic colitis
and may clinically present like adenocarcinoma.

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TROPICAL DESEASES 1

TROPICAL DISEASES

These are infections, and infestations met with in warm countries
situated between the two tropics.
They can occur elsewhere if the climate were to change to warm, in Global warming.

They form a vary large part of the diseases that you will see in
your practice.
The treatment is mainly the use of drugs but there
are specific stages of disorders where surgery is required.

1. AMEBIASIS

Amebiasis is a widely prevalent parasitic infestations encountred
in medical and surgical practice in the tropics.
It has no racial prediliction and the disease is endemic in most tropical areas.
- Infection with E. histolytica is acquired by the ingestion of
food or water containing mature cysts.
- In alkaline small bowel environment excystation, and division
occur, to form trophozoites,(amebic form) which became lodged in
the crypts of the cecum, where they usually live as commensals
(encystations take place as fecal material solidifies) and the
cysts are passed out with feces.
- Cysts of E.histolytica, in a cool moist surroundings may remain
viable for a month and are resistant to common germicides and
chlorinated water but are destroyed by heat over 50oC.
- The life cycle is represented in diagram above.

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