Amoebiasis In Children: Symptoms, Diagnosis And Treatment

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Amoebiasis In Children: Symptoms, Diagnosis And Treatment
Amoebiasis In Children: Symptoms, Diagnosis And Treatment

Video: Amoebiasis In Children: Symptoms, Diagnosis And Treatment

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Video: Amebiasis (Amoebic Dysentery) | Entamoeba histolytica, Pathogenesis, Signs & Symptoms, Treatment 2023, February
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  • Etiology
  • Epidemiology
  • Pathogenesis of amebiasis
  • Clinic of amebiasis
  • Where can a child get infected?
  • How to recognize intestinal amebiasis?
  • Disease Threats
  • Symptoms
  • Prevention measures in children
  • Treatment of amebiasis in a child

    Conservative treatment

  • Complications and consequences of amebiasis in a child
  • Prevention of amebiasis
  • You can defeat parasites!

Amebiasis in children is an anthroponous intestinal protozoan, characterized by ulcerative lesions of the colon, a tendency to protracted and chronic course and the possibility of abscesses in various organs.



What to do in such a situation? To get started, we recommend reading this article. This article details the methods of dealing with parasites. We also recommend contacting a specialist. Read the article >>>

Etiology

The causative agent Entamoeba histolytica belongs to the capcode protozoa. The life cycle of a dysentery amoeba has two stages - vegetative (trophozoite) and dormancy (cyst). The vegetative stage includes 4 forms of the development of the parasite: large vegetative, tissue, luminal and precystic. The large vegetative form (forma magna) measuring 20-60 microns differs from other amoebas in a jerky translational movement using pseudopodia, it is an erythrophage. It is found in fresh stool in acute amebiasis.

The tissue form has a size of 20-25 microns, is mobile, invades the wall of the colon. It is found only with acute amebiasis in the affected organs and rarely (only with the disintegration of ulcers) in liquid stool. The lumen form (forma minuta) has a diameter of 15-20 microns, has low mobility and is found in the stool of convalescents of acute amoebiasis, with a chronic recurrent course of the disease and in carriers of amoebas after taking a laxative. Vegetative forms of amoebas die in the patient's feces after 30 minutes.

The resting stage of a dysentery amoeba includes cysts of varying degrees of maturity. Their diameter is 8-15 m km, a mature cyst has 4 nuclei, well distinguishable when stained with Lugol's solution. Cysts are found in the feces of convalescents of acute amoebiasis, in remission in patients with chronic recurrent amoebiasis and in carriers of amoebas.

Internal structure
Internal structure
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Epidemiology

The source of the invasion is a person with amoebiasis, or a carrier of amoebas. The mechanism of infection is fecal-oral, carried out by water, food and contact-household routes. Transmission factors can be water, food, hands contaminated with amoeba cysts. Immunocompromised individuals are most susceptible to this disease. Amoebiasis is widespread in many countries, but most of the diseases occur in areas with hot climates. In the CIS, the disease is recorded mainly in Central Asia and the Caucasus.

Epidemiology
Epidemiology
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Pathogenesis of amebiasis

Infection occurs when mature cysts enter the human digestive tract. After excision in the lower part of the small or upper part of the colon, luminal forms of amoebas are formed, which multiply in the proximal part of the large intestine. Further transformation of the luminal form occurs in two ways: in some cases, the carriage of amoebas develops, in others, the luminal form penetrates under the intestinal mucosa and turns into a pathogenic tissue form.

The latter is facilitated by: an immunodeficiency state, dysbiosis of the large intestine, a deficiency of dietary protein, etc. The tissue form of amoeba secretes special substances - cytolysins, proteolytic enzymes, which enable it to melt tissues and multiply in them. Reproducing in the tissues of the intestinal wall, the amoeba causes microabscesses, which then open into the intestinal lumen, which leads to the formation of ulcers of the mucous membrane. As the disease progresses, the number of ulcers increases, while the blind and ascending intestines are mainly affected.

Etiology
Etiology
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Particularly severe lesions develop in persons with previous intestinal dysbiosis, unbalanced diet. Perforation of ulcers is accompanied by peritonitis. When deep ulcers heal and scar, bowel stricture and obstruction may develop.

The chronic course of amebiasis sometimes leads to the development of amoebo-tumor-like formations in the intestinal wall, consisting of granulation tissue, fibroblasts and eosinophilic leukocytes. Once in the blood vessels of the submucous layer of the intestine, amoeba can penetrate the hematogenous way into various internal organs, causing the development of abscesses. The most common hematogenous pathway is the liver.

Clinic of amebiasis

The incubation period is from 1 week to 3 months (usually 3-6 weeks). According to the severity of clinical manifestations, amebiasis can have an asymptomatic or manifest course. By the duration of the course - acute and chronic (with recurrent and continuous course).

Depending on the clinical manifestations, the following forms of the manifest course of amebiasis are distinguished:

  • intestinal amebiasis;
  • extraintestinal amebiasis;
  • amoebiasis of the skin. According to the severity of the course - light, moderate and heavy.

The asymptomatic form is characterized by the existence of cysts and luminal forms of amoebas, which do not cause signs of the disease, in the intestines of invaded people of different duration.

The manifest form usually occurs in the form of intestinal amebiasis (amoebic dysentery). The acute course of intestinal amebiasis is characterized by a moderate change in the general condition of the patient, most often limited to malaise, weakness, and decreased appetite. Body temperature is normal or subfebrile. Simultaneously with the general manifestations of the disease, diarrhea occurs. Initially, loose stools are abundant in volume, feces, fetid with transparent mucus, 4-5 times a day. Pain in the right iliac region (right-sided colitis) is characteristic during this period. Then the frequency of bowel movements increases up to 10-20 times a day, the content of vitreous mucus and blood in the stool increases.

The pathognomonic sign of amebiasis - a stool of the "raspberry jelly" type - is now rare. Usually there is a persistent and cramping nature of pain in hypogastrium, aggravated before defecation. When the rectum is involved in the pathological process, tenesmus appears. The abdomen is moderately distended, soft, painful on palpation along the colon.

Endoscopic examination (sigmoidoscopy, sigmoidoscopy) of the large intestine reveals ulcers up to 10-15 mm in diameter in the folds of the mucous membrane with edematous, undermined edges and a bottom covered with pus and necrotic masses. The ulcers are surrounded by a girdle of hyperemia, the mucous membrane outside the affected areas is little changed.

The acute stage of the disease without specific treatment lasts 4-6 weeks. Then comes a long (from several weeks to several months) remission. After it, an exacerbation occurs again - the disease takes on a chronic course with alternating periods of remission and exacerbation, which can continue without specific treatment for up to 10 years or more. In some patients, the disease can take on a continuous course when there are no periods of remission.

Take the amoeba test

Symptoms Answer Rapid stool Yes Not Feces with mucus Yes Not Feces with blood Yes Not Heat Yes Not Lower abdominal pain Yes Not Tormenting tenesmus Yes Not Decreased appetite Yes Not The appearance of nausea Yes Not Painful along the colon Yes Not General weakness Yes Not

The most characteristic signs of the disease for both recurrent and continuous forms of chronic amebiasis are abdominal pain, more on the right, frequent stools, periodically mixed with blood, alternating with constipation, sometimes a moderate increase in body temperature. At the beginning of the disease, the patient's well-being suffers little, then, with a prolonged course of chronic amebiasis, asthenic syndrome, hypochromic anemia develop, and body weight decreases.

In the peripheral blood, in addition to signs of anemia, eosinophilia, monocytosis, lymphocytosis, and increased ESR are observed. With intestinal amebiasis, numerous severe complications can develop. These include: pericolitis, perforated peritonitis, intestinal bleeding, intestinal stricture, prolapse of the rectal mucosa. In addition, amoebomas, which are a tumor-like infiltrate in the intestinal wall, may develop. The accession of a secondary infection leads to suppuration of the infiltrate.

Where can a child get infected?

Amoebiasis is transmitted by the fecal-oral route. Infection can occur by water, food and through direct contact with the carrier. Most often, the source of the disease is food, a little less often - water, as well as dishes, door handles, toys and other items. Infection through direct contact with a sick person occurs in unsanitary conditions.

Still, the main source is food and water, which contains cysts. After all, this parasite dies only at a temperature of about 55 ° C. But the concentration of chlorine, which is used to disinfect water or cold temperatures, are unable to destroy the pathogen.

When the amoeba enters the intestinal wall, dysentery develops. Statistics show that in children the parasite enters other organs much less frequently than in adults. But sick people are observed all year round, although the greatest percentage of the disease activity is recorded in the hot months. Therefore, in a hot period, you need to carefully monitor what the child eats.

A sick person spreads cysts. Their excretion can take years, and in just 24 hours the carrier is able to excrete 300 million cysts with feces. It is dangerous when an infected person is busy preparing food or, even more so, working in the cafeteria of an educational institution, kindergarten and at public catering establishments.

Worms and kindergarten
Worms and kindergarten
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How to recognize intestinal amebiasis?

Unfortunately, the infection itself has no symptoms, so the only symptom is parasites in the feces. But with further development, obvious signs can appear both after a few weeks and a few months after the moment of infection. The first thing that should alert you is the stabbing pain in the abdomen, as well as increased peristalsis. But it so happens that it all starts with acute symptoms such as chills, fever and severe diarrhea.

Stool disorder speaks best of the disease. And the further - the more the number of bowel movements becomes. If at first it reaches 4-6 times, and the stool is still plentiful, fecal, with a slight admixture of mucus and a pungent odor, then the frequency reaches 10-20 times a day, and the stool loses its fecal character.

Acute manifestations usually persist for a maximum of 6 weeks. They are characterized by the appearance of blood and a large amount of mucus in the stool. Decreased appetite, burning and soreness of the tongue, as well as an unpleasant taste in the mouth can also be a symptom. Without treatment, the disease can persist for years, recurring and becoming chronic.

Disease Threats

When intestinal amebiasis takes on an aggravated form, it can get to the liver. This is the most serious manifestation of the disease. Symptoms of this development include fever, and with a decrease in temperature, excessive sweating. There is bloating and pain in it, which differ in intensity, can intensify with a deep breath, give to the shoulder (to the right).

Such a development is scary because if an amoebic liver abscess becomes chronic, an abscess may break through into the abdominal or pleural cavity through the skin.

Symptoms

The latent period lasts up to 7 days (the minimum can be several hours, the average is 2-3 days). Its duration depends on the number of pathogens that have entered the body: the more there are, the shorter the incubation period.

Shigellosis can occur in children:

  • in typical or worn out form;
  • in acute (up to 2 months). protracted (up to 3 months) and chronic (more than 3 months) form;
  • smooth or complicated;
  • in mild, moderate, severe and toxic form.

The symptoms of dysentery in children depend on:

  1. Microbe type: Sonne's wand causes light, worn out forms, and Flexner's - more severe.
  2. Age: the smaller it is, the more severe the infection is.
  3. The massiveness of the infection.
  4. State of immunity.
  5. Existing concomitant pathology.

The symptoms of intoxication are:

  • headache;
  • lethargy;
  • decreased appetite or lack thereof;
  • vomiting.

Children are worried about cramping pains in the lower abdomen (often on the left), which decrease after stool. The stool, at first profuse, quickly becomes scanty, with mucus and blood streaks, with greenery. Its frequency can reach 25 or more times. Stool typical of dysentery is a scanty spit of green mucus. Frequent false urge to defecate.

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The severity of the disease is assessed depending on the severity of intoxication, the height of the fever, the frequency of the stool and its nature.

Features of the disease in children in the 1st year of life:

  1. The stool may retain a fecal character, be copious, offensive, with undigested lumps, greens and mucus.
  2. Bloating (not sucked in).
  3. Anus gaping due to straining (or prolapsed rectum).
  4. Dysentery can be combined with salmonellosis or staphylococcal infection: profuse stools and repeated vomiting quickly cause dehydration.
  5. Toxicosis develops later, manifests itself as a violation of water-mineral metabolism and heart activity.
  6. Frequent development of secondary bacterial infection (pneumonia, otitis media).

Symptoms of dehydration include:

  • dry skin and mucous membranes;
  • decrease or absence of urination;
  • high fever;
  • frequent heartbeat;
  • disturbed heart rhythm;
  • impaired consciousness, convulsions.

The toxic form of shigellosis in children is manifested by manifestations of neurotoxicosis:

  • repeated vomiting;
  • a sharp jump in temperature;
  • pallor of the skin;
  • increased heart rate, drop in blood pressure;
  • violation of consciousness;
  • convulsions.

The incubation period of amebiasis lasts from 1 week to several months. Distinguish between intestinal and extraintestinal (hepatitis, abscesses of the liver and other organs, skin amebiasis) forms of the disease.

The incubation period of amebiasis lasts from 1 week to 3 months (usually 3-6 weeks). According to the severity of symptoms, amebiasis can be asymptomatic (up to 90% of cases) or manifest; by the duration of the disease - acute and chronic (continuous or recurrent); according to the severity of the course - light, moderate, heavy.

Depending on the clinical picture, 2 forms of amebiasis are distinguished: intestinal and extraintestinal (amoebic abscesses of the liver, lungs, brain; urogenital and cutaneous amoebiasis). Amoebiasis can manifest itself as a mixed infection with other protozoal or bacterial intestinal infections (for example, dysentery), helminthiasis.

Symptoms of amoebic dysentery do not appear immediately. The incubation period is quite long.

From infection to the appearance of cysts in the stool, it takes from 1 to 44 days, to the appearance of clinical signs - from 20 to 45 days. Infection does not always lead to disease.

In some cases, there are complications from the internal organs of a metastatic nature, the most common of which is liver abscess. The onset of the disease is sudden or after a prodromal period with symptoms of weakness, pressure and mild abdominal pain, nausea and sometimes vomiting.

The first characteristic symptom of amoebic dysentery is bloody diarrhea, accompanied by severe pain along the descending part of the large intestine and excruciating tenesmus. The stool becomes very frequent and consists of mushy feces mixed with mucus and blood.

The blood in the stool mixes so closely with mucus that the latter is diffusely stained with blood, resembling raspberry jelly in appearance. The temperature in uncomplicated cases remains normal.

At elevated temperatures, cases of mixed amoebic and bacillary infections occur most often. Patients lose weight very quickly, the skin is dry and wrinkled, the stomach sinks, the facial features are sharpened.

The agonizing urge to stool becomes very frequent. Pain in the left side of the abdomen is characteristic.

The presence of pure blood in the stool indicates vascular damage. In rare cases, even fatal intestinal bleeding can occur.

Most often, death occurs in the acute period due to severe exhaustion. The chronic form can last for years, giving either periods of relative well-being, or new exacerbations.

In some cases, amoebic dysentery gives significant deviations from the typical course.

The structure of the amoeba
The structure of the amoeba
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Prevention measures in children

The measures are mirror-like simple - hygiene in everything. Of course, you can't keep track of the child, but you still need to try to control his nutrition as much as possible. Also very important:

  • instill in children neatness, love of cleanliness and hygiene;
  • boil drinking water for at least 10 minutes;
  • wash your hands after coming from the toilet or just from the street;
  • wash hands thoroughly before preparing food;
  • before cooking, you also need to wash the food well;
  • in the warm season, products must be protected from flies and other insects;

Treatment of amebiasis in a child

Treatment of amebiasis can be conservative (non-surgical) and surgical.

Conservative treatment

Specific drugs are used to treat amoebiasis.

  • Antiprotozoal drugs (for the destruction of amoebas).
  • Antibacterial drugs (antibiotics for treating infections), if there is an intolerance to antiprotozoal drugs or if complications develop).

Symptomatic treatment:

    • multivitamin preparations;
    • restoration of disturbed water-salt balance;
    • antispasmodics to eliminate pain syndrome;
    • hepatoprotectors (drugs that protect the liver).

Surgical treatment with the ineffectiveness of conservative treatment or with the threat of rupture of an abscess (abscess).

Complications and consequences of amebiasis in a child

In the intestinal form (intestinal damage):

  • perforation (rupture) of the intestinal wall;
  • peritonitis (inflammation of the peritoneum);
  • intestinal bleeding;
  • specific appendicitis (inflammation of the appendix - the appendix of the cecum);
  • prolapse of the rectum;
  • detachment of the intestinal mucosa and its gangrene (tissue necrosis);
  • stricture (narrowing) of the intestine;
  • infectious diseases (secondary infections, that is, they join the already existing amebiasis).

With extraintestinal forms (for example, damage to the liver, lungs, brain, etc.):

  • an abscess (abscess) of the liver can be complicated by a breakthrough into the abdominal cavity with the development of peritonitis or into the pericardium (heart bag) with the development of pericarditis (inflammation of the outer shell of the heart - heart bag (pericardium)). Mortality (mortality) in this course of the disease without specific treatment reaches 25% and higher;
  • lung abscesses (purulent pleurisy (purulent inflammation of the pleura (the membrane lining the inner surface of the chest wall and the outer surface of the lungs)), empyema (accumulation of pus between the pleural layers), pneumothorax (accumulation of air in the pleural cavity), hepato-pulmonary fistulas (pathological (abnormal) channels between the bile ducts and bronchi)).

Prevention of amebiasis

General sanitary measures, improvement of populated areas, control of flies, early detection and rehabilitation of sick and cyst carriers are of decisive importance.

If amoebiasis is diagnosed in a child, the prognosis will be serious and significantly aggravated by the development of complications such as liver abscess, perforation of the intestinal wall with the development of peritonitis.

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