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Amoebic Abcess: DR - Hary Bagijo SP - PD, FINASIM
Amoebic Abcess: DR - Hary Bagijo SP - PD, FINASIM
Unsanitary conditions
HIV infection
The Life Cycle
1. Cyst Stage
Infective stage
Survive from –4 to 40 Celcius
Size – 12mm
Quadrinucleated
Ingested by contact with fecally
contaminated food
Passes through stomach, excysts in
lower small bowel.
Metacystic amoeba with four cystic
nuclei from each cyst
8 Small trophozoites from each
metacystic amoeba
Trophozoites carried to cecum
The Life Cycle
The Trophozoite Stage:
10-40 qm, fragile
Uninucleate
Erythrophagocytosis
Reside, feed and multiply by binary fission in
lumen of colon
May invade – Lytic & physical mechanisms and
metastasize to liver and other extra-intestinal
sites
Galactose-containing molecules & receptors
regulate cyst formation
Precyst – Cyst – Uninucleate to Quadrinucleate
and passed in stool
The Pathogenesis
10% of infected individuals develop invasive disease
Massive Haemorrhage
Due to vasculitis of large arteries or multiple ulcers
leading to small arterial leaks
amoebomas
A granulomatous thickening of the colon resulting from
lytic necrosis followed by secondary pyogenic
inflammation, leading to fibrosis and proliferative
granulation tissue. Lesions are firm, hard, may resemble
a carcinoma.
amoebic Stricture
Resulting from fibrosis of intestinal wall. Can involve
rectum, anus or sigmoid.
The Complications
Complications of Extra-Intestinal Amoebiasis:
Amoebic Liver Abcess
Most frequent complication of amoebiasis
Male:Female Ratio = 1 in Children and infants
In adulthood = More common in young males
Third to Half may have no history of diarrhoea
Commonly found in Right Lobe of liver
Presents acutely with high fever, RUQ tenderness
Jaundice an unusual finding
Have marked leucocytosis and may have XR abnormalities
in 25 to 90% of patients
The Complications
Complications of Extra-Intestinal amoebiasis:
amoebic Peritonitis
Pleuropulmonary amoebiasis
amoebic Pericarditis
Cerebral amoebiasis
Serology:
Anti-amoebic antibodies (IgM) 70% sensitive for amoebic colitis
and 90% sensitive for amoebic liver abcess
Colonoscopy / Sigmoidoscopy
Colonoscopy preferable
Wet preps of material from ulcer-base can show
trophozoites
Positive Serology
Lesion in Liver :
Abdominal USS
Symptomatic infections
Oral Metronidazole for 10 days
Effective in eradicating amoebae in bowel lumen and
wall
Effective in eradicating extra-intestinal disease
Additional luminal agent not necessary
Vaccination:
None available currently