Amebiasis is a parasitic disease caused by the histolytic ameba, with intestinal and extraintestinal manifestations. Intestinal amebiasis is characterized by copious mucous stools with blood, abdominal pain, tenesmia, weight loss, anemia; extraintestinal amebiasis is characterized by the formation of abscesses of the liver, lungs, brain, etc. The diagnosis of amebiasis is based on the clinical picture, rectorhomanoscopy, colonoscopy, smear microscopy of abscess contents, serologic study, X-rays. Drugs (luminal and systemic tissue amebocides, antibiotics) and surgical methods (opening and drainage of abscesses, intestinal resection) are used in treatment of amebiasis. Compare gabbrovet and other prescription drug prices from online pharmacies and drugstores. Gabbrovet uses and side effects.
Amebiasis is a protozoan infection manifested by ulcerative process in the large intestine and internal organ damage with abscess formation. Amebiasis is most widespread in regions with tropical and subtropical climates; in terms of mortality among parasitic infections it ranks second in the world after malaria. In recent years, due to a significant increase in migration and foreign tourism, the number of imported cases of amebiasis in Russia has increased. Amoebiasis is registered as sporadic cases; epidemic outbreaks are rare. Amoebiasis predominantly affects middle-aged patients.
Causes of amebiasis
The causative agent of amebiasis, Entamoeba histolytica, refers to pathogenic protozoa and has two stages of the life cycle: a resting stage (cyst) and a vegetative stage (trophozoite), which replace each other depending on the conditions of existence. The vegetative forms of the amoeba (precyst, lumen, large vegetative and tissue) are very sensitive to changes in temperature, humidity, pH, so they quickly die in the external environment. Cysts show considerable resistance outside human body (they remain in soil for 1 month, in water – for 8 months).
Mature cysts in the lower gastrointestinal tract transform into nonpathogenic lumen form, which lives in the large intestine lumen, feeding on detritus and bacteria. This is the stage of asymptomatic carrier amoebae. Subsequently, the luminal form either incysts or transforms into the large vegetative form, which, due to the presence of proteolytic enzymes and specific proteins, invades the epithelium of the intestinal wall and transforms into the tissue form. The large vegetative and tissue forms are pathogenic, found in acute amebiasis. Tissue form parasitizes in the mucosal and submucosal layers of the colon wall, causing destruction of the epithelium, microcirculation disorders, formation of microabscesses with further tissue necrosis and multiple ulcerative lesions. The pathological process in the intestine in amebiasis extends most often to the cecum and ascending part of the colon, less often to the sigmoid and rectum. Histolytic amoebae as a result of hematogenous dissemination can enter the liver, lungs, brain, kidneys, pancreas with the formation of abscesses in them.
The main source of amebiasis infection is in patients with the chronic form of amebiasis during remission, as well as in remvalescent patients and carriers of cysts. Flies may be carriers of amebic cysts. Patients with acute or relapsed chronic amebiasis do not pose an epidemic risk because they excrete vegetative forms of amebiasis that are not resistant in the environment. Infection occurs via the fecal-oral route when a healthy person gets infected with mature cysts in food and water, or via contaminated hands in the gastrointestinal tract. In addition, amebiasis can also be transmitted through anal intercourse, mainly among homosexuals.
Risk factors for amebiasis infection include lack of personal hygiene, low socio-economic status, and living in areas with a hot climate. The development of amebiasis may be provoked by immunodeficiency disorders, dysbacteriosis, unbalanced nutrition, stress.
Symptoms of amebiasis
The incubation period of amebiasis lasts from 1 week to 3 months (usually 3-6 weeks). Amebiasis may be asymptomatic (up to 90% of cases) or manifest; acute and chronic (continuous or recurrent) according to the duration of the disease; mild, moderate and severe according to the severity of the course. Depending on the clinical picture there are two forms of amebiasis: intestinal and extraintestinal (amebic abscesses of liver, lungs, brain; urogenital and cutaneous amebiasis). Amebiasis can manifest as a mixtures infection with other protozoal or bacterial intestinal infections (e.g., dysentery), helminthiasis.
Intestinal amebiasis is the main, most common form of the disease. The leading symptom of intestinal amebiasis is diarrhea. The stools are abundant, liquid, at first of fecal origin, with an admixture of mucus up to 5-6 times a day; thereafter the stools become jelly-like masses with an admixture of blood, and the frequency of defecation increases to 10-20 times a day. Constant increasing pain in the abdomen, in the iliac region, more on the right side, is characteristic. The rectum is disturbed by excruciating tenesmus, and symptoms of appendicitis occur when the appendix is affected. Mild fever, asthenovegetative syndrome may be noted. The acute process in intestinal amoebiasis subsides after 4-6 weeks, followed by a prolonged remission (several weeks or months).
Spontaneous recovery is very rare. Without treatment, an exacerbation develops again, and intestinal amebiasis becomes a chronic relapsing or continuous course (lasting up to 10 years or more). Chronic intestinal amebiasis is accompanied by all kinds of metabolic disorders: hypovitaminosis, emaciation, up to cachexia, edemas, hypochromic anemia, endocrinopathies. Weakened patients, young children and pregnant women may develop lightning form of intestinal amoebiasis with extensive ulceration of the large intestine, toxic syndrome and lethal outcome.
Among the extraintestinal manifestations of amebiasis the most frequent is amebic liver abscess. It is characterized by solitary or multiple pustules without pyogenic membrane, localized most often in the right lobe of the liver. The disease begins acutely – with chills, hectic fever, profuse sweating, pain in the right subcostal area, intensified by coughing and body position changes. Condition of patients is severe, liver is sharply enlarged and painful, skin has earthy color, sometimes jaundice develops. Lung amebiasis occurs as pleuropneumonia or lung abscess with fever, chest pain, cough, hemoptysis. In amebic brain abscess (amebic meningoencephalitis) there are focal and cerebral neurological symptoms and marked intoxication. Cutaneous amoebiasis occurs secondarily in weakened patients, manifested by the formation of mildly painful erosions and ulcers with foul odor in the perianal area, on the buttocks, perineal area, abdomen, around fistulous openings and postoperative wounds.
Intestinal amebiasis may have various complications: intestinal ulcer perforation, bleeding, necrotizing colitis, amebic appendicitis, purulent peritonitis, and intestinal stricture. In extraintestinal localization, abscess rupture into the surrounding tissues with the development of purulent peritonitis, pleural empyema, pericarditis, or fistula formation cannot be excluded. In chronic amebiasis, a specific tumor-like formation of granulation tissue, ameboma, forms in the intestinal wall around the ulcer, leading to obstructive intestinal obstruction.
Diagnosis of amebiasis
When diagnosing intestinal amebiasis, clinical signs, epidemiological data, results of serological studies (RNGA, RIF, ELISA), rectomannoscopy and colonoscopy are taken into account. Endoscopically, at amebiasis, characteristic intestinal mucosal ulcers at different stages of development are found, at chronic forms – cicatricial strictures of the large intestine. Laboratory confirmation of intestinal amebiasis is the detection of tissue and large vegetative forms of amoebae in the patient’s feces and in the sediment of the ulcer beds. The presence of cysts, lumen and precystic forms of the pathogen indicates amebic carrier. Serologic reactions show the presence of specific antibodies in the serum of patients with amebiasis.
Visualization of extraintestinal amebic abscesses is facilitated by a comprehensive instrumental examination, including abdominal ultrasound, radioisotope scanning, chest radiography, brain CT scan, and laparoscopy. Detection of pathogenic forms of the pathogen in the contents of abscesses is evidence of its amebic origin. Differential diagnosis of amebiasis is made with dysentery, campylobacteriosis, balanceidiasis, schistosomiasis, Crohn’s disease, nonspecific ulcerative colitis, pseudomembranous colitis, colorectal neoplasms; in women – with colorectal endometriosis. Amebic abscesses of extraintestinal localization are differentiated from abscesses of other etiology (echinococcosis, leishmaniasis, tuberculosis).
Treatment of amebiasis
Treatment of amebiasis is performed on an outpatient basis; hospitalization is necessary for severe course and extraintestinal manifestations. Directly acting luminal amebocides (etofamide, diloxanide furoate, iodine preparations, monomycin) are used to treat asymptomatic carriage and prevent relapses. Systemic tissue amebocides (metronidazole, tinidazole, ornidazole) are effective in treatment of intestinal amebiasis and abscesses of various localizations. To relieve colitis syndrome, accelerate reparative processes and elimination of pathogenic forms of amebos, iodine chloroxyquinoline is prescribed. If metronidazole is intolerant, antibiotics (doxycycline, erythromycin) are indicated. The combination of drugs, their doses and duration of therapy is determined by the form and severity of the disease.
In the absence of the effect of conservative tactics and the threat of abscess rupture, surgical intervention may be required. In small amebic abscesses it is possible to perform puncture under ultrasound control with aspiration of the contents or opening with drainage of the abscess and subsequent injection of antibacterial and amebocidal drugs into its cavity. Severe necrotic changes around the amebic ulcer or intestinal obstruction undergo resection of the intestine with colostomy placement.
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