entamoeba histolytica treatment

 

 

 

Distribution :

•E. histolytica is worldwide in prevalence. 

• It has been found any place disinfection is poor, in all climatic zones.

• Infective structure: develop quadrinucleate pimple passed in dung of convalescents and transporters.

• It has been reported that about 10% of world population and 50% of the inhabitants of developing countries may be infected with the parasite.

Morphology :

E. histolytica occurs in 3 forms: trophozoite, precyst, and cyst.

 

Life Cycle :

E. histolytica passes its life cycle in 1 host, man.

• Infective illusion : grown-up quadrinucleate clot passed in fertilizer of convalescents and carriers.

 The cysts can remain viable under moist conditions for about 10 days. Trophozoite is not infective.
• Mode of transmission: man procures disease by gulping food and water debased with growths.

 Pathogenesis and Clinical Features:

 E . histolytica causes intestinal and extraintestinal amoebiasis.

A. Intestinal Amoebiasis 

• The typical manifestation of intestinal amoebiasis is amoebic dysentery. This may resemble bacillary dysentery, but can be differentiated on clinical and laboratory grounds.

 • In fulminant colitis, there is confluent ulceration (flask shaped ulcers) and necrosis of colon. The patient is febrile and toxic.

 • Quite frequently, there might be just the runs or ambiguous stomach side effects famously called 'awkward tummy' or 'snarling midsection.

B. Extra-intestinalAmoebiasis o Hepatic Amoebiasis :

 • The most common extra-intestinal complication of amoebiasis. 

1. Acute amoebic hepatitis. 2. Liver abscesses. • The abscess contains thick brown pus (anchovy sauce pus).

 • Jaundice develops only when lesions are multiple or when they press on the biliary tract.

 • Untreated abscesses tend to rupture into the adjacent tissues.

o Pulmonary Amoebiasis :

 • The lower some portion of the correct lung is the standard territory influenced.

 • Hepatobronchialfistula usually results with expectoration of chocolate brown sputum. The patient presents with severe pleuritic chest pain, dyspnea, and cough. o Metastatic Amoebiasis : • Involvement of distant organs by hematogenous spread and through lymphatics. • Spread to brain causes severe destruction of brain tissue and is fatal (secondary amoebic meningoencephalitis).

o Cutaneous Amoebiasis :

 • Due to fistula formation (intestine, liver, perianal). • Lesions resemble epithelioma.

o Genitourinary Amoebiasis :

 • In female, vulva, vagina or cervix may be affected by spread from perineum or fistula formation.

o Laboratory Diagnosis

 A. Diagnosis of Intestinal Amoebiasis 

1 . Stool examination • Saline preparation • Stained preparation

2 . Mucosal Scrapings

obtained by sigmoidoscopy. Examination method includes a direct wet mount, iron hemotoxylin and immunofluroscent staining.
3 . Serodiagnosis Serological tests transform into positive only in invasive amoebiasis..

 Various serological tests done include: IHA, Latex agglutination test, ELISA. 4 . ELISAs to detect Entamoeba antigens in stool are of greater sensitivity over microscopy. 5 . Molecular Method : DNA probes and PCR have been used to demonstrate parasitic genome in the stool specimen.

B . Diagnosis of Extra - intestinal Amoebiasis

 1 . Microscopy : microscopic examination of pus aspirated from liver or lung abscesses and CSF may demonstrate trophozoite of E . histolytica . Cysts are never seen in extraintestinal lesions. 2 . Liver biopsy : trophozoite of E . histolytica may be demonstrated in liver biopsy specimen, in case of amoebic hepatitis. 3 . Serological test . 4 . Radiological examination The diagnosis of amoebic liver abscess is based on the detection (generally by USG or CT) of one or more space occupying lesions in the liver and a positive serologic test for antibodies against E . histolytica antigens.

o Treatment Three classes of drug are used in the treatment of amoebiasis.

• Luminal amoebicides: Diloxanide furoate, iodoquinol, paromomycin, and tetracycline operation in the intestinal lumen but not in tissues.
• Tissue amoebicides: Emetine, chloroquine, etc. are effective in systemic infection, but less effective in the intestine.

• Both luminal and out amoebicides: Metronidazole and chaperon compounds music pretension tinidazole and ornidazole fake on both sites and are the counterirritant of alternate for treating amoebic colitis and amoebic

 liver abscess.