Amoebiasis - Symptoms, Forms, Diagnosis And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Amebiasis

Amoebiasis is an intestinal infection. The disease is characterized by a long course and leads to the formation of ulcers in the large intestine and other organs. Amoeba, as a microorganism, was first discovered by the scientist F. A. Leshem from St. Petersburg. This discovery happened back in 1875. The amoeba was found in the stool of a patient who was suffering from bloody diarrhea.

In 1883, R. Koch from Egypt found amoebae in the purulent cavities of the liver and in ulceration of the intestines. As an independent disease, amoebiasis began to be considered only in 1891.

Content:

• The causative agent of the disease is the simplest amoeba
• Infection routes
• Forms of amebiasis
• Diagnostics of the amebiasis
• Treatment of amoebiasis
• Disease prognosis
• Prevention

The causative agent of the disease is the simplest amoeba

Amoebiasis is caused by the simplest microorganism - amoeba. It goes through 2 stages of the life cycle - the vegetative stage and the cyst stage (at this time, the amoeba is at rest).

During the vegetative stage, the amoeba can take on various forms:

1. Tissue form. Such amoebas are very mobile and can penetrate into various environments. During this period, they lead to acute inflammation of the internal organs of their carrier.
2. Large vegetative form. Such amoebas have the ability to absorb red blood cells.
3. Enlightened form. Amoebas lose mobility. In this form, microorganisms exist in the intestines during a person's recovery.

In the cyst stage, the amoeba can be presented in two forms:

• Precystic form. Amoeba is characterized by low mobility. In this form, it exists outside the human body. The microorganism retains its activity for several months, if there are favorable conditions for this.
• Cyst. Such amoeba can exist outside the human body for several months. She lives in the soil for 7 days. The amoeba is not afraid of cold, it retains its activity at -20 degrees. The microorganism dies when it dries.

Unlike cysts, vegetative forms of amoeba are not stable in the external environment. If the disease has an acute course, luminal and tissue forms of amoebas will be present in the patient's feces. When a person begins to recover, then cysts, luminal and precystic forms are sown in the feces.

Cyst is able to maintain its vital activity outside the human body for a long time. It is represented by a spherical quadrangular vacuole, which is surrounded by a colorless shell. After the cyst enters the small intestine, a mature amoeba emerges from it and begins to divide. Each mature amoeba produces 8 new amoebas with one core. All young amoebas have the ability to reproduce. They enter the large intestine in a vegetative form.

Infection routes

The spread of amebiasis is a sick person. It releases various types of amoebas and cysts into the external environment. Moreover, an infected person is contagious after the end of the acute phase of the disease. He can isolate amoeba for several years. The average number of amoebas that leave a sick person per day is 9000 million. During the acute phase of amoebiasis, a person is not contagious, since he releases vegetative forms of amoebas into the external environment.

People become infected when cysts enter the body. The introduction takes place during the consumption of unwashed products, or with poor hygiene (disease of dirty hands). In terms of infection, the danger is posed by unwashed dishes, things, bedding. Infection can be carried by cockroaches and flies.

Most often men aged 20-50 years suffer from amebiasis. After an infection, immunity is not developed. Amoebiasis is widespread in countries with humid and hot climates, although infections occur throughout the world.

Once in the intestine, the cyst transforms into a vegetative form and invades the intestinal wall. In it, she begins to produce substances that destroy the tissues of the organ and lead to the formation of ulcerative defects. They appear from areas of erosions and abscesses, which are represented by nodules. When the nodule collapses, vegetative forms of amoebas emerge from it, and an ulcer appears in its place. Each area of ulceration can reach 25 mm in diameter.

Ulcers have the ability to merge. The more there are, the higher the likelihood of damage to the muscular layer of the intestine with its further perforation. This situation is life threatening, as it leads to the development of peritonitis.

Damage to the vascular walls leads to bleeding of varying intensity. When the intestinal walls begin to heal, this can provoke a narrowing of the lumen of the organ and its obstruction.

If amoebas enter the bloodstream, then they are able to spread throughout the body, penetrate into the liver, lungs, and brain. If the disease is chronic, then there is a high probability of growth in the intestinal lumen of a tumor-like amoeba. It will be represented by granulation tissue and the body's own cells.

Forms of amebiasis

There are 3 forms of amebiasis:

• Intestinal form.
• Extraintestinal form (hepatic, etc.)
• Skin form.

Intestinal form of the disease

Most often it is the intestinal form of the disease. The prodromal period after the entry of amoebas into the body until the first symptoms of the disease appear can last from 7 days to 3 months

The severity of the symptoms of the disease depends on the severity of its course. They build up gradually.

Patients have the following signs of infection:

• An increase in body temperature to subfebrile levels.
• Increased weakness.
• Headaches.
• Increased fatigue.
• Abdominal pain that won't be too intense. To a greater extent, a person indicates a feeling of intestinal distention.

The main symptom of the intestinal form of the disease is diarrhea. It is abundant, it happens up to 10-30 times a day. The stool contains mucus. As the disease progresses, diarrhea worsens. Feces lose their shape, become liquid. In addition to mucus, blood appears in the feces. Outwardly, the chair resembles raspberry jelly.

Abdominal pain intensifies, proceeds as contractions. Acute symptoms can persist for up to 7 days. Then comes relief. The disease goes into remission. However, after a few weeks or even months, it may worsen. These symptoms are characterized by recurrent intestinal amebiasis.

Sometimes the disease is continuous. From time to time, the symptoms fade away, after which they gain strength again. If a person does not receive treatment, then amoebiasis can bother him for many years (up to 10 or more).

The chronic form of infection leads to asthenic syndrome, proteins leave the human body, vitamins are washed out. The tongue becomes thickly coated, the appetite disappears. The skin becomes dry, facial features sharpen. On palpation of the abdomen, a person experiences pain.

Intestinal amebiasis must be treated. If therapy is absent, then this threatens the development of severe complications. The heart suffers, the patient develops bradycardia and arrhythmia. The myocardium lacks nutrients.

The nervous system with long-term current amoebiasis is depleted. A person falls into depression or apathy, he has frequent mood swings, irritability increases.

If the disease is severe, it can lead to complications such as:

• Rupture of the intestinal wall.
• Intestinal strictures.
• Intestinal bleeding.
• Pericolitis. The danger is pericolitis, which develops in about 10% of patients. Symptoms of the disease resemble peritonitis. The intestinal walls stick to each other due to fibrin plaque. Adhesions and ulcers form on them.
• Purulent peritonitis. The accession of a purulent process is accompanied by increased pain, an increase in body temperature to febrile levels, vomiting, bloating, and a significant deterioration in well-being.
• Tumor growth in the intestine (amoeba). It grows in the cecum and in the ascending colon. Amoeboma often leads to the development of intestinal obstruction.
• Intestinal polyps. With amebiasis, adenomatous neoplasms are often formed in the intestine.
• Rectal prolapse.
• Amoebic appendicitis. This pathology has a severe course and in 90% of cases is fatal. The complication develops during the acute course of the disease.

Hepatic form of the disease

If amoebas enter the liver, then they can provoke the development of hepatitis, or an abscess of organ tissue. The person suffers from intense pain, which will be concentrated in the right hypochondrium.

Amebic liver abscesses are complicated by purulent forms of peritonitis, pleurisy, pericarditis. The mortality rate among patients exceeds 25%.

The doctor, during palpation of the liver, notes its increase in size, increased density, soreness. Sometimes a person's skin and mucous membranes turn yellow. Body temperature can reach high levels.

The pains can radiate to the shoulder joint, with a deep breath they become more intense. A change in body position can provoke an attack.

The rise in temperature is not persistent. It can change during the day. The person looks emaciated, his skin is dry, loses its former elasticity. Eyes sink, cheekbones protrude. In general, the patient looks sickly.

Swelling of the lower extremities is often observed. The abdomen is enlarged. If the disease becomes chronic, then exhaustion will only increase. Liver abscess can be single or multiple. Hepatic amebiasis is a serious illness that often leads to death. If the abscess breaks through, then the pathological masses enter the abdominal cavity, which leads to a clinic of peritonitis. Purulent masses can enter the pleura and lead to the development of pneumonia, or lung abscess. Such inflammation often takes on a long course.

Other forms of amebiasis

Together with the blood flow, amoebas are able to spread throughout the body. Sometimes they reach the brain, which leads to symptoms of its defeat. The patient suffers from severe pain, he has convulsions, sensitivity worsens, paralysis or paresis of the extremities may occur.

Also, amoebas are able to penetrate the spleen, kidneys, and female genitals. In these organs, they multiply, which leads to the formation of abscesses in them. Symptoms will be associated with a deterioration in the functioning of a specific system of the human body.

Cutaneous form of the disease

When amoebas infect the skin, erosion and ulceration appear on them. First of all, the buttocks and the perineal area are affected. Ulcerative defects differ in depth, it does not hurt much, but a pungent unpleasant smell emanates from them.

Diagnostics of the amebiasis

To diagnose amebiasis, the patient is examined, his complaints are listened to, and laboratory tests are prescribed.

According to the results of a clinical blood test, an increase in leukocytes will be noticeable. Moreover, their performance can increase significantly. ESR is also growing.

The feces are examined for the presence of amoebas in it. If there are symptoms of extraintestinal amebiasis, then it is necessary to analyze sputum, pus from abscesses or ulcerative defects.

If the luminal forms of amoebas and cysts are not found in the feces, then this does not exclude the diagnosis of "amoebiasis". The fact is that in order to detect protozoa, feces must be handed over to the laboratory no later than 15 minutes after the incident of defecation. The analysis must be repeated several times. When the disease begins to fade away, the stool is examined immediately after the patient takes a laxative. If it is impossible to deliver the material to the laboratory immediately after the act of defecation, then it must be preserved. It is examined using Lugol's solution. Also, amoebas can be cultivated on nutrient media, but it will take too long to wait for the results of such a study.

An auxiliary diagnostic method is immunological analysis. XRF is considered the most effective, followed by the complement binding reaction. Another diagnostic method is contamination of secretions with amoeba from animals that live in the laboratory.

Instrumental diagnostic methods can include:

• Sigmoidoscopy. During the examination, the doctor examines the condition of the sigmoid and rectum. This method allows visualizing ulcerative defects, erosions, cysts, polyps and other pathological formations that may appear against the background of amebiasis.
• Ultrasound of organs that can be affected by amoebae.
• CT scan of the brain, lungs and other internal organs. The study is prescribed in the case when there is a suspicion of the spread of amoebas with blood flow.
• Irrigoscopy. This is a method for examining the large intestine. The patient is injected with a contrast agent and several pictures are taken on an X-ray machine.
• Radioisotope methods. These studies make it possible to distinguish amoebiasis from bacterial damage to the intestines or other organs.
• Microresonance tomography. The method is indicated for those patients who are in a weakened state.

Treatment of amoebiasis

Treatment of amoebiasis involves taking drugs from 3 different groups:

• Direct amoebocytes: Yatren, Hiniofon, diiodoquine, tetracycline antibiotics. These drugs are harmful to the luminal forms of amoebas. They are prescribed to patients with chronic illness, as well as to recovered people, in order to prevent the development of a relapse of the disease.
• Tissue amoebocytes: Emetin, Hingamin, Ambilgar, Dehydroemetin. Medicines of this group destroy amoebae, which parasitize tissues and mucous membranes. They are used to treat an acute form of the disease or amoebiasis that develops outside the intestines.
• Universal amebocytes: Flagil, Trichopolum, Tinidazole, Furamid. These drugs help destroy the parasite cells from the inside. They act on their proteins, stop the reproduction of amoebas, and also stimulate the formation of radicals that destroy these simplest microorganisms.

In addition, patients with amoebiasis are prescribed drugs aimed at restoring intestinal microflora (probiotics). Depending on the developing complications, the patient may be shown drugs to protect the liver, heart, to increase immunity.

If the patient develops anemia, drugs with a high iron content and blood substitutes are prescribed, in rare cases - hemotransfusin. It is imperative to take complex vitamins: B vitamins, ascorbic acid.

With a severe form of amoebiasis, infusion therapy is carried out, i.e. rheopolyglucin, glucose-salt solutions are injected intravenously.

Treatment regimens for amebiasis

Treatment of the intestinal form of the disease is carried out according to the following schemes:

• Metronidazole orally 3 times a day for 8-10 days. Calculation of the dose of 30 mg / kg / day.
• Tinidazole. Children under 12 years of age are prescribed 50 mg / kg / day, but not more than 2 g per dose. For patients over 12 years old 2 g / day in 1 reception. The course of treatment lasts 3 days.
• Ornidazole. Children under 12 years of age are prescribed 40 mg / kg / day, but not more than 2 g in 2 divided doses. Patients over 12 years of age are prescribed 2 g / day in 2 divided doses. The course of treatment is 3 days.
• Secnidazole. Children under 12 years of age are prescribed 30 mg / kg / day in 1 dose. Patients over 12 years of age are prescribed 2 g per day once. The course of treatment is 3 days.

If a patient is diagnosed with an amoebic abscess, then the treatment regimen will be as follows:

• Metronidazole - 30 mg / kg / day in 3 divided doses. The course of treatment is 8-10 days.
• Tinidazole. Children under 12 years of age are prescribed 50 mg / kg once a day. Patients over 12 years old are prescribed 2 g per day once. The course of treatment lasts 5-10 days.
• Ornidazole. Children under 12 years of age are prescribed 40 mg / kg / day, but not more than 2 g in 2 divided doses. Patients over 12 years of age are prescribed 2 g / day in 2 divided doses. The course of treatment is 5-10 days.
• Secnidazole. Children under 12 years of age are prescribed 30 mg / kg / day in 1 dose. Patients over 12 years of age are prescribed 2 g per day once. The course of treatment is 3 days.

An alternative treatment regimen for amoebic abscess is carried out with the use of Dehydroemetine dihydrochloride. Patients are administered 1 mg / kg / day intramuscularly, but not more than 60 mg. The course of treatment is 4-6 days. After completion of therapy with this drug, patients with liver damage are prescribed Chloroquine 600 mg per day for 2 days, after which the dose is reduced to 300 mg per day and taken for another 14-21 days.

In order to completely destroy the protozoa that could remain in the intestinal lumen, after the completion of the selected treatment regimen, patients are shown taking luminal amoebicides. It can be Etofamide (take it for weeks at 20 mg / kg / day in 2 doses) or Paromomycin (take it for 5-10 days at 1000 mg / day in 2 doses).

Disease prognosis

The earlier the disease is detected and treatment is started, the more favorable the prognosis. If there is no therapy, then amoebiasis will progress, leading to severe complications and death.

Prevention

To prevent infection, the following guidelines must be followed:

• Timely identify people with infection and prescribe treatment for them.
• Put all those who have been ill on dispensary registration.
• Observe sanitary and hygienic measures: process foods that are to be eaten, drink clean water, wash hands, etc.

Author of the article: Danilova Tatyana Vyacheslavovna | Infectionist

Education: in 2008 received a diploma in General Medicine (General Medicine) at the Pirogov Russian Research Medical University. Immediately passed an internship and received a diploma of a therapist