Amoebiasis Question and Answers

Amoebiasis

Disease Is Caused By Infection By Protozoan Parasite.

Entamoeba histolysis which gets lodged in the large intestine causes dysentery and may spread to the liver and other organs.

Management of Amoebiasis

Investigations of Amoebiasis

• Stool examination: Shows various forms of E. histolytic
• Serological test
• Sigmoidoscopy for ulcer.
• Immunofluorescence test for autoantibodies

Treatment of Amoebiasis

• Nitroimidazole classes of antimicrobial agents are the main drugs of treatment.
  • Metronidazole 400 to 800 mg TDS 5 to 7 days.
  • Tinidazole 2 gm as single or divided three days dose.
  • Secnidazole 2 gm as a single dose.
  • Diloxanide furoate: It should be added because it has effect on cysts. It is given 500 mg TDS for 10 days.
    Metronidazole has no effect on cysts.
• General supportive measures and fluid and electrolyte imbalance correction are there.
• The diet given should be soft, liquid, or semi­liquid.

Amoebic Dysentery

Answer. Amoebic dysentery is caused by a protozoan called Entamoeba histolytica.

• Entamoeba histolytica exists in two forms, i.e. trophozoite and cystic stage.
• Trophozoites are responsible for the production of disease and cysts are responsible for transmission of disease.
• Reservoir of infection: Man is the only known reservoir.
• Mode of transmission: Fecal­oral route, i.e. through contaminated food and water.
• The incubation period is two to four months or longer.

Symptoms Of Amoebiasis

1. The patient has diarrhea and passes 10–15 stools per day.
2. Presence of abdominal pain.
3. Stools consist of blood and mucus.
4. Flatulence is present.
5. Fever is present between 38 and 40 degrees with rigors.

Signs Of Amoebiasis

1. Palpation of the abdomen shows diffuse tenderness.
2. Chronic cases show a thickened tender sigmoid colon.
3. Amoeba is felt as a sausage-shaped mass in the right iliac fossa.
4. Tender hepatomegaly is present.

 Signs Symptoms And Treatment Of Amoebiasis

Amoebiasis is the infection of the gastrointestinal tract by the protozoan parasite Entamoeba histolytica.

Symptoms Amoebiasis

• The patient has diarrhea and passes 10–15 stools per day.
• Presence of abdominal pain.
• Stools consist of blood and mucus.
• Flatulence is present.
• Fever is present between 38 and 40° with rigors.

Signs amoebiasis

• Palpation of the abdomen shows diffuse tenderness.
• Chronic cases show a thickened tender sigmoid colon.
• Amoeba is felt as a sausage-shaped mass in the right iliac fossa.
• Tender hepatomegaly is present.

Treatment Amoebiasis

• Diloxanide furoate is given 500 mg TDS × 10 days.
• Metronidazole Or Ornidazole 500 mg TDS × 5 days
• Secnidazole plus 2 gm single dose is given
• Nitazoxanide 500 mg BD is given
• Dehydroemetine 1.5 mg / kg / day × 5 days IM

Question 2. Write a short note on Hepatic Amoebiasis.

Answer. It is the most common complication of amoebiasis.

• Pathophysiology of Hepatic Amoebiasis
• Amoeba after reaching the liver multiply and block small intrahepatic portal radicles, producing thrombosis and infarction resulting in necrosed areas surrounded by areas of congestion.
• The necrotic area consists of degenerated liver cells, leukocytes, connective tissue strands, and enmeshed in between Entamoeba histolytica.
• Cytolytic enzymes liberated from amoebae destroy the liver parenchyma and fusion of these small necrosed areas results in abscess formation.

Amoebiasis Symptoms 

• An abscess generally is single but may be multiple. Its walls are lined by a shaggy necrotic zone in whose center there is thick reddish brown pus containing fragments of liver tissue, necrotic material, and erythrocytes.
• The pus typically is called “Anchovy sauce” and is sterile on culture.

Clinical Features Hepatic Amoebiasis

• The onset of Amoebic hepatitis is insidious and the patient may come with irregular or intermittent fever
• There is a stretching sensation in the liver area.
• Gradually with the progression of the disease, anorexia hepatic pain and epigastric discomfort appear
• Examination shows a uniform tender hepatomegaly
• There are signs of toxemia

Amoebiasis Treatment

• Jaundice is not very common
• When hepatitis progresses to a liver abscess, pain in the liver area becomes a constant feature
• Intermittent fever, loss of weight, lassitude, peculiar sallowness of skin, irritability, and sleeplessness are common features.

Investigations of Hepatic Amoebiasis

• TLC and DLC show leukocytosis with an increase in polymorphs.
• A stool examination is done and cysts and trophozoites of
• The amoebic fluorescent antibody titer is positive.

Management of amoebic liver abscess/Hepatic Amoebiasis

• Early cases are responding well with metronidazole 800 mg TID for 5 days or tinidazole 2 gm daily for three days.
• Luminal amoebicide: Diloxamide furoate 500 mg 8 hourly for 10 days should be given to determine the luminal cyst.
• If the abscess is large and does not respond to chemotherapy repeated aspiration under ultrasonic guidance is required.
• Rupture of abscess into the peritoneal cavity requires immediate aspiration or surgical drainage.