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(Amoebic
Dysentery) Case
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Introduction:
Amoebiasis protozoal infection of human beings initially involves the colon, but may spread to soft tissues,
most commonly to the liver or lungs, by contiguity or hematogenous or lymphatic dissemination.
Amoebiasis is the third leading parasitic cause of death worldwide, surpassed only by malaria and
schistosomiasis. On a global basis, amoebiasis affects approximately 50 million persons each year, resulting in
nearly 100,000 deaths.
Etiologic Agent:
Enatamoeba Histolytica
Incubation Period: The incubation period in severe infection is three days. In subacute and
chronic form it lasts for several months. In average cases the incubation period varies from three to four weeks
Period of Communicability: The microorganism is communicable for the entire duration of the illness.
Modes of Transmission:
1. The disease can be passed from one person to another through fecal-oral transmission.
2. The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and
proctogenital sexual activity.
3. Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy
vegetables or foods contaminated with fecal materials containing E. histolytica cysts.
Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure to flies, use of night
soil for fertilizing vegetables, and through unhygienic practices of food handlers.
Clinical Manifestations:
Hepatic
1.
o Pain at the upper right quadrant with tenderness of the liver
o Jaundice
o Intermittent fever
o Loss of weight or anorexia
o Abscess may break through the lungs, patient coughs anchovy-sauce sputum
Clinical Features:
1. Onset is gradual
2. Diarrhea increases and stool becomes bloody and mucoid
3. In untreated cases:
B. The esophagus is a muscular tube extending from the pharynx to the stomach.
1. Esophageal openings include:
b. The lower esophageal sphincter (LES), or cardiac sphincter, which normally remains closed and
opens only to pass food into the stomach.
C. The Stomach is a muscular pouch situated in the upper abdomen under the liver and diaphragm. Te
stomach consists of three anatomic areas: the fundus, body (i.e., corpus), and antrum (i.e., pylorus)
D. Sphincters. The LES allows food to enter the stomach and prevents reflux into the esophagus. The
pyloric sphincter regulates flow of stomach contents (chyme) into the duodenum.
E. The small intestine, a coiled tube, extends from the pyloric sphincter to the ileocecal valve at the large
intestine. Sections of the small intestine include the duodenum, jejunum and ileum
F. The large intestine is a shorter, wider tube beginning at the ileocecal valve and ending at the anus. The
large intestine consists of three sections:
1. The cecum is a blind pouch that extends from the ileocecal valve to the vermiform appendix.
2. The colon, which is the main portion of the large intestine, is divided into four anatomic sections:
ascending, transverse, descending and sigmoid.
G. The ileocecal valve prevents the return of feces from the cecum into the small intestine and lies at the
upper border of the cecum.
H. The appendix, which collects lymphoid tissues, arises from the cecum.
1. An inner mucosal layer lubricates and protects the inner surface of the alimentary canal.
3. A layer of circular smooth muscle fibers is responsible for movement of the GI tract.
4. A layer of longitudinal smooth muscle fibers also facilitates movement of the GI tract.
5. The peritoneum, an outer serosal layer, covers the entire abdomen and is
composed of the parietal and visceral layers.
II. Function. The GI system performs two major body functions: digestion and
elimination.
A. Digestion of food and fluid, with absorption of nutrients into the bloodstream,
occurs in the upper GI tract, stomach and small intestines.
1. Digestion begins in the mouth with chewing and the action of ptyalin, an
enzyme contained in saliva that breaks down starch.
2. Swallowed food passes through the esophagus to the stomach, where digestion continues by several
processes.
a. Secretion of gastric juice, containing hydrochloric acid and the enzymes pepsin and lipase ( and
renin in infants)
3. From the pylorus, the mixed stomach contents (i.e. chyme) pass into the duodenum through the
pyloric valve.
4. In the small intestine, food digestion is completed, and most nutrient absorption occurs.
Digestion results from the action of numerous pancreatic and intestinal enzymes (e.g., trypsin, lipase,
amylase, lactase, maltase, sucrase( and bile.
B. Elimination of waste products through defacation occurs in the large intestines and rectum. In the large
intestine, the cecum and ascending colon absorb water and electrolytes from the now completely
digested material. The rectum stores feces for elimination.
Pathophysiology
Laboratory Diagnosis:
1. Stool exam (cyst, white and yellow pus with plenty of amoeba)
2. Blood exam (Leukocytosis)
3. Proctoscopy/Sigmoidoscoppy
Diagnosis of amoebiasis can be very difficult. One problem is that other parasites and cells can look very
similar to E. histolytica when seen under a microscope. Therefore, sometimes people are told that they are
infected with E. histolytica even though they are not. Entamoeba histolytica and another ameba, Entamoeba
dispar, which is about 10 times more common, look the same when seen under a microscope. Unlike infection
with E. histolytica, which sometimes makes people sick, infection with E. dispar does not make people sick and
therefore does not need to be treated.
If you have been told that you are infected with E. histolytica but you are feeling fine, you might be infected
with E. dispar instead. Unfortunately, most laboratories do not yet have the tests that can tell whether a person
is infected with E. histolytica or with E. dispar. Until these tests become more widely available, it usually is
best to assume that the parasite is E. histolytica.
A blood test is also available but is only recommended when your health care provider thinks that your infection
may have spread beyond the intestine (gut) to some other organ of your body, such as the liver. However, this
blood test may not be helpful in diagnosing your current illness because the test may still be positive if you had
amoebiasis in the past, even if you are no longer infected now.
Complications:
1. Amebic colitis
o Fulminant or necrotizing colitis
o Toxic megacolon
o Ameboma
o Rectovaginal fistulas
2. Amebic liver abscess
o Intrathoracic or intraperitoneal rupture with or without secondary bacterial infection
o Direct extension to pleura or pericardium
3. Brain abscess
Treatment:
Several antibiotics are available to treat amoebiasis. Treatment must be prescribed by a physician. You will
be treated with only one antibiotic if your E. histolytica infection has not made you sick. You probably will be
treated with two antibiotics (first one and then the other) if your infection has made you sick.
Nursing Management:
Methods of Prevention:
1. Health education
2. Sanitary disposal of feces
3. Protect, chlorinate, and purify drinking water
4. Observe scrupulous cleanliness in food preparation and food handling
5. Detection and treatment of carriers
6. Fly control (they can serve as vector)