amibiasis
TRANSCRIPT
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CASE PRESENTATION
Dr.Yassin
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History
• 5 years old boy admitted through GIT clinic with :
• Hx of on/off Abdominal pain.
• bloody diarrhea and fever for last 8 month.
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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.
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History
• 1st attack occurred after swallwing water from swimming pool.
• No vomiting.
• No jundice.
• No arthralgia.
• No rash.
• No travel.
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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.
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History
• Perinatal:
• Allergy:
• Diet:
• Vaccination:
• Family history :
• Social:
unremarkable
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EXAM
• Looks well.
• Vitally stable
• Growth parameter
• Wt: 16 kg 5th
• Ht:112 cm 50th
• CVS,CHEST,ABDOMIN, CNS,ENT musculoskeletal : within normal.
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LAB
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LAB
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LAB
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LAB
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LAB
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LAB
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summery
• 5 years old boy Hx recurrent Amebiasis (bloody diarrhea, tenesmus ,abdominal pain)
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impresssion
• Chronic amibiasis. Acute on top of chronic.
• IBD.
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Amebiasis
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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.
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ETIOLOGY
• Entamoeba histolytica.
•
• Entamoeba dispar.
• E. moshkovskii.
• E. coli.
• E. hartmanni.
• E. gingivalis.
• E. polecki.
Asym
ptomatic
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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 .
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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.
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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
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CLINICAL MANIFESTATIONS
90% asymptomatic
10%Amebic colitis
<1% Disseminated
disease liver abscess
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CLINICAL MANIFESTATIONS
• colicky abdominal pains
• Diarrhea .bloody and mucoid stained
• tenesmus.
• fever . in only ⅓ of patients. But may indicate liver involvement.
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investigation
• CBC: anemia and slight leukocytosis
• LFT: high liver enzymes mainly ALK if liver involved.
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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.
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investigation
• ELISA : detection antigens in stool by enzyme-linked immunosorbent assays.
• PCR from stool.
• Serology :serum antiamebic antibody
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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.
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differential diagnosis
• bacterial colitis (Shigella, Salmonella, Escherichia coli, Campylobacter, Yersinia, Clostridium difficile) .
• viral colitis (cytomegalovirus)
• inflammatory bowel disease.
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COMPLICATIONS
• necrotizing colitis.
• toxic megacolon.
• extraintestinal extension.
• local perforation and peritonitis.
• chronic amebiasis with bouts of abdominal pain and bloody diarrhea
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TREATMENTInvasive disease
metronidazole Then followed
by
Paromomycin
Tinidazole Diloxanide furoate
Iodoquinol
ASYMPTOMATIC
Paromomycin
Diloxanide furoate
Iodoquinol
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TREATMENT
• E. histolytica infection is asymptomatic in about 90% of persons, but it has the potential to become invasive and should be treated.
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PREVENTION
• Hand washing.
• Clean bathrooms and toilets often.
• Avoid sharing towels.
• Avoid raw vegetables when in endemic areas.
• Boil water.
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THANK YOU