Disentri Amoeba

EPIDEMIOLOGY
• Estimates of the prevalence of various E. Hystolitica infections from 1
to 40% of the population in Central and South America, Africa and
Asia, and 0.2-10.8% in endemic areas of developed countries such as
the United States
• E. histolytica infection is a common cause of acute diarrhea in
developing countries
ETIOLOGY & RISK FACTORS
• Swallowing cysts from food or water contaminated with feces is the
main route of transmission of E. histolytica
• Low hygiene and sanitation standards, especially related to
population density, tropical climate, food and water contamination by
feces, as well as inadequate faecal disposal, are risk factors in
developing countries
• In developed countries, the risk factors include communal life, oral
and anal sex, lost immune system, and migration or tourism from
endemic areas.
PATHOGENESIS
• Histolitic form (trophozoite) → invasion of intestinal mucosal
epithelial cells → necrosis of intestinal mucosal tissue histolisin
enzyme production → invasion of submucosal tissue → amoebic ulcer
-> ulcer dilates and interconnects to form submucous sinuses →
malabsorption → damage to surface absorption → Increased mass
intraluminal → Increased intraluminal osmotic pressure → bloody
diarrhea (due to inflammation)
DIAGNOSIS
• Clinical Symptoms
• Diarrhea bleeding and slimy
• BAB frequency is generally less than bacillary dysentery (<10x / day)
• Severe abdominal pain (colic)
• Constitutional symptoms usually do not exist (fever is only found in 1/3 cases)
• Physical Examination
• Look for signs of dehydration
• Sigmoid tenderness
• Supporting Examination
• Fecal examination
• Macroscopic: an amoebic dysentery can be established if a trophozoite is found in the
stool
• Benzidine Test
• Microscopic: fecal leukocytes (a sign of colitis), fecal blood test (+)
• Regular blood tests: leukocytosis (5,000-15,000 cells / mm3), sometimes
leukopenia can be found
THERAPY
• Anti-amebic is given with indication:
• Entamoeba hystolistica trophozoite is found in microscopic examination of
feces
• Bloody diarrhea stay after therapy with 2 antibiotics in a row (each given for 2
days), which is usually effective for bacillary dysentery.
• Therapy chosen as anti-intestinal intestinal in children is Metronidazole 30-
50mg / kgBB / day divided into 3 doses for 10 days. If dysentery is indeed
caused by E. hystolistica, the condition will improve in 2-3 days of therapy
• Education to always maintain personal hygiene and the environment:
hand washing, garbage in place, proper use of septic tanks
COMPLICATION
• Dehydration
• Electrolyte disorders, especially hyponatremia
• Seizures
• Protein loosing enteropathy
• Sepsis and DIC
• Uremic Hemolytic Syndrome
• Malnutrition / malabsorption
• Hypoglycemia
• Prolapse of the rectum
• Reactive arthritis
• Guillain-Barre syndrome
• Ameboma
• Toxic Megacolone
• Local perforation
• Peritonitis
PROGNOSIS
• Prognosis is determined by the severity of the disease, proper early
diagnosis and treatment and ameba sensitivity to the drug given
• In general, the prognosis of amebiasis is good, especially in cases
without complications