Amoebiasis

Notes
  • An infection of Entamoeba histolytica that mainly affects colon.
Symptoms
  • Amoebic dysentery

_Abdominal pains

_Bloody/mucusal diarrhea

_Sometimes constipation

_Constant urge to empty the bowel

_Flatulence

_Fatigue

  • Asymptomatic cases in cyst carriers
  • Amoebic liver abscess

_Loss of weight

_Pain right hypochondrium referred to

  right shoulder

_Fever

_Profuse sweeting and rigor

_Palpable liver

_Basal lung signs

_Tenderness and rigidity in right

  hypochondrium

Diagnosis
  • Stool microscopy for trophozoites and cyst
  • Full Blood Count (FBC)
  • In case of suspected liver amoebic liver abscess

_Liver ultra-sound

_Needle aspiration  for microscopy

  • Chest X-ray
Differential
  • Ulcerative Colitis
  • Infectious diarrhea
  • Pyogenic Liver Abscess
  • Echinococcal Liver Cyst
  • Fascioliasis
  • Necrotic Hepatoma
  • Typhoid
  • Abdominal abscess
  • Cholecystitis
  • Viral Hepatitis
  • Diverticulitis
Prevention
  • Proper sanitation
Management
  • Invasive intestinal amoebiasis

Either;

_Tab/susp Metronidazole 800mg TID x 5/7. 3-7 years; 200mg QID x 5/7. 7-10 years; 200-400mg TID.

Or;

_Tabs Ornidazole: 0.5gm to 1.5gm daily for 1 - 7 days;

Or;

_Tabs Satranidazole: 300mg BD for 3-5 days.

Or;

-Tab Secnidazole:  Adults; 2g stat, children; 30mg/kg stat.

Or;

_Tabs Tinidazole 2g daily for 2-3 days

  • Cyst carriers

Either;

_Fixed dose combination of Metronidazole 250mg + Diloxanide 250mg: One tab TID x 5/7 (10/7 in refractory cases). Children 5-12 years; ½ tab or 10mL TID x 5/7.Children below 5 years: 5mL TIDx5/7.

_Only for food handlers.

Or:

_Tabs Diloxanide 500mg BD X 10/7

_Only for food handlers

Or:

-Tab Secnidazole:  Adults; 2g OD x 3/7, children; 30mg/kg OD x 3/7.

  • Amoebic liver abscess:

Either;

_Tabs / Susp Metronidazole 30-50mg /kg/day in 3 divided doses for 7-10 days.

Or:

_Tab Secnidazole: 1.5g daily in one or several doses for 5 days, children; 30mg/kg /day in one or several divided doses for 5 days.

Or:

_Tabs Tinidazole 2g daily for 3-5 days.

_Surgical drainage or aspiration for the pointing liver abscess (this will avoid liver rupture).

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