Entamoeba histolytica: Difference between revisions

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Entamoeba histolytica
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== Background ==
+
==Background==
=== Microbiology ===
+
===Microbiology===
* Intestinal protozoan parasite within the genus ''[[Entamoeba species|Entamoeba]]''
 
* Microscopically distinguishable from the non-pathogenic ''E. dispar'', ''E. moshkovskii'', and ''E. bangladeshii''
 
   
 
*Intestinal protozoan parasite within the genus ''[[Entamoeba species|Entamoeba]]''
=== Epidemiology ===
 
 
*Microscopically distinguishable from the non-pathogenic ''E. dispar'', ''E. moshkovskii'', and ''E. bangladeshii''
* Present worldwide, but most disease occurs in the developing world
 
* Causes 34 to 50 million cases annually and up to 100,000 deaths
 
   
 
===Epidemiology===
== Clinical Manifestations ==
 
=== Amoebic diarrhea and dysentery ===
 
* [[Causes::Amoebic diarrhea]], with or without dysentery, is common
 
** About 15 to 30% of cases involve [[Causes::amoebic dysentery]] (with macroscopic or microscopic blood)
 
* Typically a subacute onset over 3 to 4 weeks and abdominal pain
 
** However, can be up to months
 
* Fever is rare, even in dysentery
 
* In children, can lead to intussusception, perforation, and necrotizing colitis
 
   
 
*Present worldwide, but most disease occurs in the developing world
=== Amoebic liver abscess ===
 
 
*Causes 34 to 50 million cases annually and up to 100,000 deaths
* [[Causes::Amoebic liver abscess]] is far more common in men than women, and rare in children
 
* Symptoms progress over 2 to 4 weeks, with fever, cough, and abdominal pain
 
** The pain is typically a dull ache in the right upper quadrant or epigastrium
 
   
 
==Clinical Manifestations==
=== Disseminated amoebiasis ===
 
 
===Amoebic Diarrhea and Dysentery===
* Metastatic infections are possible, most often from direct extension of a liver abscess
 
* Most commonly spreads to chest, with empyema, bronchohepatic fistula, pericarditis
 
* Cerebral disease is rare but can happen
 
   
 
*[[Causes::Amoebic diarrhea]], with or without dysentery, is common
== Diagnosis ==
 
 
**About 15 to 30% of cases involve [[Causes::amoebic dysentery]] (with macroscopic or microscopic blood)
* Microscopically distinguishable from the non-pathogenic ''E. dispar'', so needs molecular tests to confirm diagnosis
 
 
*Typically a subacute onset over 3 to 4 weeks and abdominal pain
 
**However, can be up to months
 
*Fever is rare, even in dysentery
 
*In children, can lead to intussusception, perforation, and necrotizing colitis
   
 
===Amoebic Liver Abscess===
== Management ==
 
=== Liver abscess ===
 
* Either
 
** [[Is treated with::Metronidazole]] 750 mg PO tid for 10 days
 
** [[Is treated with::Tinidazole]] 2 g PO daily for 5 days
 
* Followed by a luminal agent, either
 
** [[Is treated by::Paramomycin]] 10 mg/kg PO tid for 5 to 10 days
 
** [[Is treated by::Diloxanide furoate]] 500 mg PO tid for 10 days
 
   
 
*[[Causes::Amoebic liver abscess]] is far more common in men than women, and rare in children
=== Diarrhea ===
 
 
*Symptoms progress over 2 to 4 weeks, with fever, cough, and abdominal pain
* [[Is treated by::Tinidazole]] 2 g PO daily for 5 days
 
 
**The pain is typically a dull ache in the right upper quadrant or epigastrium
* Followed by a luminal agent, as above
 
   
 
===Disseminated Amoebiasis===
=== Asymptomatic carriage ===
 
  +
* Treat with a luminal agent, as above
 
 
*Metastatic infections are possible, most often from direct extension of a liver abscess
 
*Most commonly spreads to chest, with empyema, bronchohepatic fistula, pericarditis
 
*Cerebral disease is rare but can happen
  +
 
==Diagnosis==
  +
 
*Microscopically indistinguishable from the non-pathogenic ''E. dispar'', so needs molecular tests to confirm diagnosis
  +
 
==Management==
 
===Liver Abscess===
  +
 
*Either
 
**[[Is treated with::Metronidazole]] 750 mg PO tid for 10 days, or
 
**[[Is treated with::Tinidazole]] 2 g PO daily for 5 days
 
*Followed by a luminal agent, either
 
**[[Is treated by::Paramomycin]] 10 mg/kg PO tid for 5 to 10 days, or
 
**[[Is treated by::Diloxanide furoate]] 500 mg PO tid for 10 days
  +
*May need surgery or aspiration if the lesion is large or medication has failed
  +
 
===Diarrhea===
  +
 
*[[Is treated by::Tinidazole]] 2 g PO daily for 5 days
 
*Followed by a luminal agent, as above
  +
 
===Asymptomatic carriage===
  +
 
*Treat with a luminal agent, as above
 
{{DISPLAYTITLE:''Entamoeba histolytica''}}
 
{{DISPLAYTITLE:''Entamoeba histolytica''}}
 
[[Category:Protozoa]]
 
[[Category:Protozoa]]

Revision as of 09:01, 24 August 2020

Background

Microbiology

  • Intestinal protozoan parasite within the genus Entamoeba
  • Microscopically distinguishable from the non-pathogenic E. dispar, E. moshkovskii, and E. bangladeshii

Epidemiology

  • Present worldwide, but most disease occurs in the developing world
  • Causes 34 to 50 million cases annually and up to 100,000 deaths

Clinical Manifestations

Amoebic Diarrhea and Dysentery

  • Amoebic diarrhea, with or without dysentery, is common
    • About 15 to 30% of cases involve amoebic dysentery (with macroscopic or microscopic blood)
  • Typically a subacute onset over 3 to 4 weeks and abdominal pain
    • However, can be up to months
  • Fever is rare, even in dysentery
  • In children, can lead to intussusception, perforation, and necrotizing colitis

Amoebic Liver Abscess

  • Amoebic liver abscess is far more common in men than women, and rare in children
  • Symptoms progress over 2 to 4 weeks, with fever, cough, and abdominal pain
    • The pain is typically a dull ache in the right upper quadrant or epigastrium

Disseminated Amoebiasis

  • Metastatic infections are possible, most often from direct extension of a liver abscess
  • Most commonly spreads to chest, with empyema, bronchohepatic fistula, pericarditis
  • Cerebral disease is rare but can happen

Diagnosis

  • Microscopically indistinguishable from the non-pathogenic E. dispar, so needs molecular tests to confirm diagnosis

Management

Liver Abscess

  • Either
  • Followed by a luminal agent, either
  • May need surgery or aspiration if the lesion is large or medication has failed

Diarrhea

  • Tinidazole 2 g PO daily for 5 days
  • Followed by a luminal agent, as above

Asymptomatic carriage

  • Treat with a luminal agent, as above