Table of contents:
- What is amebiasis?
- Diagnostics of the amebiasis
- Symptoms of amebiasis
- Treatment of amebiasis
- Prevention of amebiasis
- 1 What is amebiasis?
- 2 Diagnosis of amebiasis
3 Symptoms of amebiasis
- 3.1 Extraintestinal amebiasis
- 3.2 Intestinal amebiasis
- 4 Treatment of amebiasis
- 5 Prevention of amebiasis
Amoebiasis is a disease caused by protozoal infection and is accompanied by damage to the large intestine. Intestinal amoebiasis is most common in countries with subtropical and tropical climates. The low level of sanitation in underdeveloped countries is the cause of high mortality from parasitic intestinal ailments. In our country, the incidence of amebiasis has increased significantly due to the development of foreign tourism and the influx of migrants from countries with hot climates. In this article we will tell you everything about amebiasis: what is it, how it is diagnosed, stages, symptoms, treatment and prevention.
What is amebiasis?
If we talk about amoebiasis, what it is, then it is worth mentioning that this ailment refers to anthroponous invasions that have a fecal-oral transmission mechanism. The disease is characterized by the appearance of recurrent chronic colitis, which has extraintestinal manifestations.
Most often, this term is applied to a disease called amoebic dysentery. The disease is caused by the parasite Entamoeba histolytica. It is a dysentery or histolytic amoeba that lives in the human colon. The life cycle of this parasite consists of vegetative and cystic stages. Moreover, in the dysentery variety of amoebas, there are four types of the vegetative stage.
Diagnostics of the amebiasis
What is intestinal amebiasis, we figured it out, now we will consider how this ailment is diagnosed. To make the correct diagnosis, it is important to take into account the results of laboratory tests and studies, the clinical picture of the disease and data on the epidemiological state in the region.
The diagnosis is more often based on the results of a parasitological study. In the test material, vegetative and tissue forms of the parasite, as well as trophozoites-erythrophages, can be found. The presence of a dwarf amoeba or an intestinal amoeba cyst in the feces is a confirmation of the disease. Diagnosis of amebiasis is carried out by research:
- biopsy material;
- rectal swabs;
- contents from the hepatic abscess.
In the presence of signs of the disease and negative results of the study, it is advisable to carry out serological tests for diagnosis, which are based on the detection in the patient's blood of specific antibodies to the infection that causes amebiasis. To do this, use the following techniques:
- PCR allows you to detect the DNA of the parasite in the feces;
- analyzes for inhibition of gemaglutination.
If a person has an intestinal form of infection, then serological tests give a positive result in 75% of cases. In women, men and children with extraintestinal amebiasis, serological tests are positive in 95% of cases.
For parasites that provoke extraintestinal amebiasis, in addition to blood tests, an instrumental examination is performed:
With the help of such studies, it is possible to identify the place of localization of the parasite, the number and size of abscesses. In addition, such examinations help monitor the effectiveness of treatment.
Symptoms of amebiasis
According to the WHO classification, this ailment is divided into manifest and asymptomatic. This classification includes dysenteric and extraintestinal amebiasis.
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A complication of the intestinal form of the disease is extraintestinal amebiasis. When an amoeba penetrates from the intestine by a hematogenous or direct route into other organs, the disease becomes extraintestinal. Most often, hepatic abscess or amoebic hepatitis develops, which is chronic, acute or subacute. This form can appear months or years after the first infection.
An acute type of amoebic hepatitis usually appears on the background of intestinal amebiasis. In this case, the following symptoms are present:
- enlarged liver;
- the organ is hard and slightly painful;
- subfebrile temperature;
Signs of amoebic liver abscess are as follows:
- enlargement and soreness of the liver;
- chills, profuse sweating at night;
- jaundice sometimes develops.
With a breakthrough liver abscess or hematogenous spread of parasites, the following forms of extraintestinal amebiasis may appear:
- Pleuropulmonary. The disease is characterized by the development of pleural empyema, fistula abscesses (hepatic-bronchial) or lungs. In this case, the patient complains of cough, chest pain, shortness of breath, fever, chills, pus and blood can be found in sputum, leukocytosis in blood tests.
- Cerebral. This form develops with hematogenous spread of infection. Multiple or single abscesses are found in the brain, often localized in the left hemisphere. The disease has an acute onset, a lightning-fast course and ends with the death of the patient. This form is very rarely diagnosed during a patient's life.
- Amebic pericarditis develops as a result of the breakthrough of the hepatic abscess through the diaphragm into the pericardium. This complication can be fatal due to cardiac tamponade.
- Amoebiasis of the skin. This form usually appears as a secondary process in emaciated and debilitated patients. At the same time, ulcers and erosion are found in the perianal region, on the buttocks and in the perineal region.
- Urogenital. It develops as a result of direct contact of parasites through the ulcerated intestinal mucosa in the genitals.
If the patient has intestinal amebiasis, the symptoms of the disease depend on the form and stage of the disease. So, there are chronic and acute dysentery colitis. In this case, there is a mild, moderate and acute form of the disease. The latent course of the disease lasts from a week to several months.
- frequent stools (first up to 6 times with the content of fecal mucus, then up to 20 times with an admixture of mucus and blood, feces resemble raspberry jelly);
- body temperature can be within normal limits or subfebrile (high numbers are noted only in severe disease);
- the phenomena of intoxication are absent in a mild form, but may be present in severe cases;
- pain in the lower abdomen is in a severe form of the disease (pain intensifies during bowel movements);
- decreased appetite, nausea and sometimes vomiting;
- on palpation along the large intestine, a soft, painful abdomen is felt.
After 1-1.5 months, the acute process ends and a period of remission begins, which can last up to a month. After that, the symptoms of the disease return again. If left untreated, it can last for years.
The chronic course is characterized by a recurrent or continuous form of the disease. In the first case, exacerbations are replaced by a short remission, during which there is a slight soreness, rumbling, flatulence, and upset stools.
With a continuous chronic course, the symptoms of the disease either increase or decrease slightly. Against this background, there is a strong exhaustion of patients, the development of asthenic syndrome, decreased performance, enlarged liver, hypochromic anemia.
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Treatment of amebiasis
All drugs that are used to treat various forms of amoebiasis can be divided into luminal (contact) and systemic amoebicides (tissue). The first of them affect intestinal luminal types of infection.
For the treatment of patients who are asymptomatic carriers of parasites, contact amoebicides are used. They are also advised to be used after completion of therapy with systemic drugs to prevent relapse.
If it is not possible to prevent re-infection, the use of luminal amoebicides does not justify itself. Such drugs can be prescribed in the presence of epidemiological indications for people working in the field of catering.
Luminal amoebicides include the following drugs:
- Diloxanide furoate;
- Etofamid (Kythnos).
Systemic tissue amoebicides include the following tablets:
- Metronidazole (Trichopolum);
If intestinal amebiasis is diagnosed, treatment is carried out using 5-nitroimidazoles. The same applies to abscesses of various localization. In addition to these drugs, for the treatment of invasive amoebiasis, especially hepatic amoebic abscesses, it is recommended to use Dehydroemetine dihydrochloride.
Even if non-pathogenic species of amoebas are detected in the feces, treatment with amoebicides is indicated, since the likelihood of the concomitant pathogenic form of amoebiasis increases.
After successful treatment of hepatic abscesses, the residual cavities dissolve within several months (less often up to a year). With amoebic dysentery, it is recommended to additionally prescribe antibiotics, since the risk of developing peritonitis is very increased.
Prevention of amebiasis
If amoebiasis is diagnosed in the region, prevention is aimed at identifying infected individuals in risk groups, their sanitation and treatment. It is also important to break the transmission mechanism. The following categories of the population fall into the risk group:
- patients with gastrointestinal tract pathology;
- residents of areas without sewage systems;
- employees of catering establishments, greenhouses, greenhouses, food trade, sewage and treatment facilities;
- as well as those who returned from amoebiasis-endemic regions and countries.
Patients who have recovered must be under dispensary supervision throughout the year. They are examined once a quarter. As for the measures that relate to breaking the transmission routes of infection, they are aimed at protecting facilities from infection with parasites, arranging sewage systems, and supplying clean drinking water and food. An important link in the prevention of amebiasis is health education.