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Michael John R. Aguilar, RMT
Michael John R. Aguilar, RMT
Michael John R. Aguilar, RMT
AGUILAR, RMT
Introduction
Epidemiology
Pathogenesis
Pathology
Clinical features
Laboratory diagnosis
Management
•Amebiasis ia an infection with the intestinal protozoan
Entamoeba histolytica .
•90% asymptomatic.
liver abscess
•Alcoholics
•Immunocompromised
(HIV)
male homosexuals
During amoebiasis there is a significant decrease in absolute
quantification of Bacteroides, Clostridium coccoides,
Clostridium leptum, Lactobacillus and an increase in
Bifdobacterium species.
Lactobacillus species might be protective in the context of
protozoan infections (Preidis et al., 2011; Travers et al.,
2011).
Thus a decrease in protective, commensal Lactobacillus
Colon (primarily
in the cecum),
sigmoid colon,
and
rectum
2 types of
ulcers :
nodular and
irregular
Intervening
mucosal folds
may appear
normal
lumen
Mucosa
a
Submucosa : susceptible to the
lytic action of the parasite,
and produces
abundant microhemorrhages
INTESTINAL AMEBIASIS:
•Symptomatic amebic colitis develops 2 - 6 weeks after
ingestion of infectios cysts.
•Gradual onset of lower abdominal pain,mild
diarrhea,malaise,weight loss,back pain.
•Caecal movements may mimic acute
appendicitis
•Stools will contain little fecal matter and will consist of
mainly of blood and mucus.
Fulminant intestinal infection
•Clinical features: Severe abdominal pain
High Fever
Profuse diarrhoea
Occurs
predominantly in
children
Also patients
receiving
glucocorticoids
Megacolon
•Patient will be having shock like
features
•Severe bowel dilation with
intramural air.
Syndrom of Postamebic
AMEBIC LIVER
ABSCESS:
•Febrile,Rt upper quadrent pain(dull or pleuritic) radiating to the
shoulders.
•Complication
•Cerebral Involvement
Occurs in 0.1% patients.
Syptoms depends on size and site of lesion.
•Chronic granuloma arising in the large bowel.
•MC : Caecum
•C/f: Pyrexia,
Mass in RIF
Blood stained mucoid diarrhoea.
Specimen collection :
Intestinal amoebiasis Stool samples
Extraintestinal amoebiasis Aspirated pus
Direct examination Saline and iodine wet mounts
Culture
Immunodiagnosis
Cyst
s
Tissue amoebicides
Intestinal and Extra intestinal amoebicides
• Nitroimidazoles: Metronidazole, Tinidazole,
Ornidazole, Secnidazole, Satranidazole, Nimorazole
•Alkaloids: Emetine and Dehydroemetine
Extra intestinal amoebicides: Chloroquine
Luminal amoebicides
Amides: Diloxanide furoate, Nitazoxanide
Quinolines: Iodoquinol, Quiniodochlor
Antimicrobials: Paromomycin, Tetracyclines
•Tender hepatomegaly .
LFT Normal
•Well defined hypoechoic
lesion 11.1 x 8.2 x 7.8
•hyperechoic septation
Treatment Given
•Inj Metronidazole was started .
Soft ,
Hepatomegaly.
USG
•:Features S/o liver abscess (volume 2006cc) involving the right
lobe of liver with ? Focal subcapsular rupture.
•Moderate ascitis
Abscess of right lobe
of liver.
Sloughed out
wall of the
amebic abscess
on right lobe
of liver .
CT scan of the abdomen showing irregular wall thickening of the caecum.