The Health Significance Of The Clinical Manifestations Of Intestinal Amoebiasis Infection

Funom MakamaStarred Page By Funom Makama, 1st Apr 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Diseases & Infections

The incubation period varies from a few weeks to months. Clinical manifestations of Amoebiasis can be grouped into acute dysentery, non-dysenteric and hepatic amoebiasis.

Acute Amoebic Dysentery

This presents with sudden onset of lower abdominal pain and diarrhea with blood and mucus in stools. The frequency ranges from 3 to 10 in a day. At times, watery diarrhea with large amount of blood and mucus may occur. Constitutional symptoms are mild and these include low grade fever and vague discomfort. Palpation of the abdomen reveals colonic tenderness and mild hepatomegaly. The feces is semisolid or liquid, showing fecal matter mixed with blood and mucus. Microscopic examination shows erythrocytes, a smaller number of leucocytes and trophozoites of E. histolytica. In the majority of cases, the condition subsides after several weeks even without treatment, to exacerbate again with dietary irregularity, psychological stress or other factors. Complications are rare but in a few cases, extensive destruction of mucosa and submucosa may lead to severe hemorrhage and occasionally perforation. Rectal prolapsed, intussuception and colonic stricture may develop in some. Amoebomas may develop in the cecum or other parts of the colon and these may be mistaken for neoplasms. These resolve completely with emetine and any surgical intervention for these lesions should be done only after histological diagnosis.

Non-dysenteric Amoebiasis

This is a common mode of presentation in endemic areas. The condition starts insidiously with abdominal discomfort, flatulence, intermittent diarrhea with constipation, and the presence of mucus in stools. Asymptomatic intervals and periods of dyspepsia alternate for many months or years. Vague general symptoms like feverishness, mild depression, fear and anxiety may be prominent. Physical examination may reveal palpable, tender cecum and sigmoid and sometimes tender hepatomegaly. An amoebic granuloma (Amoeboma) may be felt as a sausage-shaped mass in the right iliac fossa and this may be mistake for malignancy. Mucosal ulcers may be seen on sigmoidoscopy. Examination of the mucus collected by sigmoidoscopy may show the active trophozoite. Repeated examination of fresh stool or sigmoidoscopic specimen may be necessary to establish the diagnosis. Sigmoidoscopic biopsy reveals the ulceration and the parasite in the mucosa.

Hepatic Amoebiasis

Hepatic involvement is very common in the tropics. Many patients give a history of alcoholism. Around 50% of patients suffering from hepatic amoebiasis give history of dysentery. Liver involvement manifests as insidious onset of pain in the right hypochondrium or right lower chest with fever, chills and sweating. Loss of weight and anemia may be pronounced. In the early stage, the liver is enlarged as a whole. The pathological process is not inflammatory, but it consists of multiple necrotic lesions caused by amoebae diffusely distributed in the liver. In this stage, the organ is enlarged as a whole and it is acutely tender. This stage may persist for varying periods and many resolve either spontaneously or with treatment, without proceeding to abscess formation.

In those in whom abscess develops, the liver is considerably enlarge and tender, When the abscess spreads to the abdominal walls, there is superficial edema and severe local tenderness. The majority of liver abscesses are in the right lobe. Left lobe lesions are palpable over the epigastrium. Diaphragmatic involvement causes pleuritic pain in the right lower chest. Physical examination reveals diminished air entry, impaired percussion note and crepitations over the lower part of the right chest. Jaundice is rare. Blood shows mild to moderate leukocytosis (about 12 to 14,000/cmm) with polymorphonuclear cells dominating the field. The ESR is usually high. Fluoroscopy reveals elevation of the right dome of the diaphragm and diminished movement. Ultrasound, CT scan and isotopic scanning help to locate the site of the abscess.

Complications of liver abscess include rupture into neighboring organs or cavities leading to peritonitis, right sided empyema, broncho-hepatic fistular, and pericarditis. Cutaneous amoebiasis occurs over the genitalia, perianal region, opening of sinuses and around colostomy wounds. Rarely metastatic lesions from the liver develop in the lungs and brain. Rupture of a liver abscess into the peritoneum causes the clinical picture of an acute abdominal emergency with shock.

For more Health Articles, visit the following links:
1. Fitness And Exercise From A Doctor’s Perspective: Maintaining The Lifestyle
2. Special Types Of Anemia: Sideroblastic Anemias And Paroxysmal Nocturnal Hemoglobinuria (PNH)
3. Diphtheria: The Health Significance Of Its Clinical Diagnosis And Phases Of Treatment

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Comments

author avatar Fern Mc Costigan
4th Apr 2014 (#)

Nice description of this problem Dr. Makama! Can I ask you if you please write something about the Shingles

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author avatar Funom Makama
14th Apr 2014 (#)

Okay Fern.... I will do so, just give me some time, since I am so so busy these days... Thanks a lot for your contribution

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