The causative agent of amebiasis is Entamoeba histolytica (histolytic amoeba), belonging to the simplest. The life cycle of the parasite is represented by two successive stages depending on the environmental conditions: cysts (resting stage) and tropositis (vegetative form). Trosophyte goes through a number of stages of development, each of which can last for a long time:
- fabric form - characteristic of acute amebiasis, found in the affected organs, rarely in the feces,
- large vegetative form - lives in the intestines, absorbs red blood cells, is found in feces,
- luminal form - characteristic of chronic amebiasis, is also found in the remission stage in the feces after taking a laxative,
- predtsistnaya form - as well as luminal, characteristic of chronic amebiasis and amebiasis in remission (convalescence).
The source of infection is patients with a chronic form of amebiasis in remission and cyst carriers. In the acute form of the disease or exacerbation of the chronic, patients release into the environment unstable vegetative forms of Entamoeba histolytica that do not pose an epidemiological hazard.
The mechanism of infection is fecal-oral. The transmission path of the causative agent of amebiasis - food, water, contact. Once in the lower parts of the gastrointestinal tract, mature cysts turn into a translucent non-pathogenic form that feeds on intestinal bacteria and detritus. In the future, this form either re-turns into cysts, or becomes a large vegetative form of the parasite. The latter produces proteolytic enzymes that allow it to penetrate into the thickness of the intestinal wall, where it turns into a tissue form.
The tissue form of the causative agent of amoebiasis parasitizes in the submucosal and mucous layer of the walls of the large intestine, leading to the gradual destruction of epithelial cells, the formation of microabsities and impaired microcirculation. All this results in the formation of multiple ulcers of the large intestine. The pathological process is localized predominantly in the area of the cecum and the ascending part of the colon, much less frequently affects the rectum and sigmoid colon.
With blood flow, histolytic amoebas are spread throughout the body and enter the internal organs (pancreas, kidneys, brain, lungs, liver), leading to the formation of abscesses in them.
The factors that increase the risk of amebiasis infection are:
- low socioeconomic status
- living in regions with hot climates,
- non-compliance with personal hygiene,
- unbalanced nutrition
- intestinal dysbiosis,
Forms of the disease
On the recommendation of WHO, adopted in 1970, the following forms of amoebiasis are distinguished:
Russian infectiologists regard the cutaneous and extraintestinal forms of the disease as a complication of the intestinal form.
The most dangerous complication of extraintestinal amebiasis is perforation of amebic abscess. It is observed 10–20% of cases of liver amebiasis and is accompanied by very high mortality (50–60%).
Intestinal amebiasis can occur in the form of acute or chronic (recurrent or continuous) processes of varying severity.
Often, amebiasis is registered as a mixed infection, along with other protozoal and bacterial intestinal infections.
Symptoms of amebiasis
The incubation period lasts from a week to several months, but most often it is 3–6 weeks.
Symptoms of amebiasis are determined by the clinical form of the disease.
With intestinal amebiasis, pains in the abdomen arise and gradually increase in the patient. Occurs frequent stools. Fecal masses contain a significant amount of mucus and blood, as a result of which they acquire the characteristic appearance of raspberry jelly.
Simultaneously with the onset of symptoms of colitis, an intoxication syndrome develops, which is characterized by:
- low-grade fever (less commonly, it may be febrile, i.e. above 38 ° C),
- general weakness, decreased performance,
- loss of appetite.
The acute course of intestinal amebiasis without treatment lasts 4–6 weeks. Spontaneous recovery and complete rehabilitation of the patient's body from the pathogen is extremely rare. Most often, without treatment, the disease turns into a chronic, relapsing form in which exacerbations occur every few weeks or months.
Chronic intestinal amebiasis without adequate therapy lasts for decades. It is characterized by the development of disorders of all types of metabolism (anemia, endocrinopathy, hypovitaminosis, depletion up to cachexia). When chronic amebiasis is combined with other intestinal infections (salmonellosis, shigellosis), a typical clinical picture of a severe intestinal illness is formed, accompanied by severe signs of intoxication and serious disorders of water and electrolyte balance.
Extraintestinal manifestation of amebiasis is most often amebic liver abscess. Such abscesses are localized in the right lobe of the liver, multiple or single abscesses, devoid of pyogenic membrane.
The disease begins with a sudden increase in temperature to 39-40 ° C, which is accompanied by a strong chill. The patient has severe pain in the right hypochondrium, which increases with the change of body position, sneezing, coughing. The general condition is deteriorating rapidly. The liver significantly increases in size and becomes sharply painful on palpation. The skin becomes earthy in color, in some cases jaundice develops.
Amoebic pneumonia occurs with marked inflammatory changes in the lung tissue. The disease has a long course and in the absence of specific therapy can lead to the formation of lung abscesses.
Amoebic meningoencephalitis (amebic abscess of the brain) occurs with pronounced symptoms of intoxication and the appearance of cerebral and focal neurological symptoms. For amoebic meningoencephalitis is characterized by the formation of multiple abscesses, mostly localized in the left hemisphere.
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The main symptom of cutaneous amebiasis is a low-painful ulcers with subdued uneven edges with an unpleasant odor. Most often, ulcers form on the skin of the perineum, genital organs, as well as in the area of postoperative wounds and fistulas.
Diagnosis of amebiasis
Diagnosis of amebiasis is carried out on the basis of characteristic clinical symptoms, data of epidemiological history, as well as the results of laboratory and instrumental studies.
The diagnosis is confirmed by the discovery of a large vegetative and tissue form of the causative agent of amoebiasis in the fecal masses, sputum, contents of abscesses, separated from the bottom of the ulcer defects. For the purpose of their detection perform microscopy of native smears, stained by Heiderhain or Lugol solution. Detection of a luminal, precision form of Entamoeba histolytica or cysts in a smear indicates only infection of the subject, and not the presence of a disease in him.
In the laboratory diagnosis of amebiasis, the following methods are used:
- cultivation of amoebas on artificial nutrient media,
- infection of laboratory animals,
- serological research (IFA, RIF, RNGA).
If necessary, perform a colonoscopy or rectoromanoscopy, computed tomography, a survey radiography of the abdominal cavity.
In general, a blood test reveals changes characteristic of any acute inflammatory process (leukocytosis, leukocyte shift to the left, increase in erythrocyte sedimentation rate).
Amebiasis is widely distributed in countries with subtropical and tropical climates.
Amebiasis requires differential diagnosis with the following diseases:
- acute intestinal infections that occur with signs of colitis (balantidiasis, salmonellosis, escherichiosis, shigellosis),
- non-infectious colitis (ischemic colitis, Crohn's disease, ulcerative colitis),
- purulent cholecystocholangitis,
- malignant neoplasm of the colon,
- hepatocellular carcinoma,
- hepatic echinococcosis,
- right-sided exudative pleurisy,
- skin cancer.
Hospitalization for amebiasis is indicated only in the case of severe disease or the development of its extraintestinal forms. In other cases, the treatment of amebiasis is carried out in polyclinic conditions.
With asymptomatic carriage of the histolytic amoeba, as well as with the aim of preventing exacerbations, luminal amebocides of direct action are prescribed. In the treatment of intestinal amebiasis, as well as amoebic abscesses, tissue amebocides are used, which have a systemic effect. Specific treatment of amebiasis cannot be carried out during pregnancy, as these drugs have a teratogenic effect, i.e. they can cause fetal abnormalities.
With the ineffectiveness of conservative therapy and the threat of the spread of a purulent process, indications for surgery appear. For small single amebic abscesses, it is possible to carry out their puncture (performed under ultrasound control), followed by aspiration of purulent contents and washing the cavity with a solution of amoebicidal preparations. For large abscesses, surgical opening of the cavity is performed followed by drainage.
Pronounced necrosis of the intestinal wall around the amoebic ulcer or its perforation are indications for emergency surgical intervention - resection of the colon section, in some cases it may be necessary to apply a colostomy.
Possible consequences and complications
Complications of the intestinal form of amebiasis are:
- perforation of the intestinal wall with the development of peritonitis - a complication characteristic of severe forms of the disease and is the cause of mortality in 20-45% of those who died from amebiasis. Clinically manifested by the emergence and rapid increase in the intensity of the severity of the symptom complex of acute abdomen,
- penetration of ulcers of the large intestine into other organs of the abdominal cavity,
- pericolitis - is registered in 10% of patients with amebiasis. It is characterized by the development of adhesive fibrous peritonitis more often in the cecum or the ascending part of the colon. The main clinical sign of the disease is the formation of a painful infiltrate with a diameter of 3–15 cm, an increase in body temperature, and localized tension of the muscles of the anterior abdominal wall. Pericolitis responds well to specific treatment and does not require surgery,
- Amebic appendicitis is an acute or chronic inflammation of the appendix. Surgical intervention in this case is undesirable, as it can provoke a generalization of invasion,
- intestinal obstruction — developed as a result of cicatricial strictures of the large intestine, is characterized by a clinic of low dynamic intestinal obstruction with typical pain syndrome, palpated by painful dense infiltration, abdominal distension and asymmetry,
- amoebic tumor (ameboma) is a rare complication of amebiasis. Formed in the ascending or cecum, much less in the splenic or hepatic flexures of the colon. Surgical treatment does not require, as well lends itself to specific conservative therapy.
More rare complications of the intestinal form of amebiasis are prolapse of the rectal mucosa, colon polyposis, intestinal bleeding.
Amebiasis most often affects children of older age groups and middle-aged people. In the overall structure of mortality from parasitic infections, it ranks second, second only to malaria.
The most dangerous complication of extraintestinal amebiasis is perforation of amebic abscess. The breakthrough of hepatic amoebic abscess can occur in the subdiaphragmatic area, limited by adhesions, the abdominal cavity, bile ducts, chest, subcutaneous or perirenal cellulose. This complication is observed in 10–20% of cases of liver amebiasis and is accompanied by very high mortality (50–60%).
Without adequate treatment, amebiasis takes a protracted chronic course, is accompanied by the development of abscesses in the internal organs, a violation of all metabolic processes and over time becomes the cause of the death of the patient.
Against the background of the specific therapy being carried out, patients are rapidly improving their health.
In some patients after a course of amebiasis treatment for several weeks, complaints about the manifestations of irritable bowel syndrome persist.
Possible recurrences of amebiasis.
To prevent further spread of infection, the following sanitary-epidemiological measures are carried out:
- Isolation of the patient with amoebiasis is stopped only after a complete sanation of the intestine from the histolytic amoebae, which should be confirmed by the results of a sixfold examination of the feces,
- convalescents are under observation at an infectious diseases specialist for 6–12 months,
- surrounded by the patient conduct regular ongoing disinfection using a 2% cresol solution or a 3% lysol solution.
In order to prevent infection with amoebiasis should:
- carefully observe personal prevention measures,
- wash vegetables and fruits under running tap water, pour boiling water over them,
- Do not drink water from doubtful sources (it is best to give preference to bottled water from reputable manufacturers).
Individuals who undergo epidemiologically unfavorable amebiasis regions are given individual chemoprophylaxis using universal amebocidal agents.
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Education: She graduated from the Tashkent State Medical Institute with a degree in medicine in 1991. Repeatedly took advanced training courses.
Work experience: anesthesiologist-resuscitator of the urban maternity complex, resuscitator of the hemodialysis department.
The information is generalized and is provided for informational purposes only. At the first signs of illness, consult a doctor. Self-treatment is dangerous to health!
Amebiasis is an infectious parasitic disease that affects mainly the large intestine and, in some cases, the internal organs.
Most often, amebiasis infects people in developing countries with low levels of sanitation.
The disease is common in countries with a hot climate, most common in unsanitary conditions with a high risk of faecal contamination. Mexico and India are endemic countries, but large outbreaks are recorded in affluent countries, such as a large outbreak in Chicago during the 1933 World's Fair. Currently, cases of the disease in developing countries are registered with tourists and migrants from endemic regions. Sometimes amebiasis occurs in the middle lane, mostly in summer.
The source of infection is only a person with amebiasis or amoebic carrier. Infection occurs through the fecal-oral route when consuming infected with cysts of water and fresh vegetables and greens. The disease is transmitted by direct contact (for example, during anal intercourse). Cysts may additionally spread by cockroaches and flies. In a warm humid environment, parasite cysts can survive up to 2-4 weeks.
Etiology What kind of disease?
Amebiasis is an infection of the human body with parasites.Today the disease is a problem for countries with a low standard of living. Most foci of the disease are found in tropical and subtropical countries. Amebiasis is a disease that is one of the most common in the world. Also, this disease is one of the most common causes of death in developing countries. In the first place in terms of the number of deaths is malaria, followed by amebiasis. This disease is a world medical and social problem of backward countries.
There is statistics on the infection of humans with Entamoeba histolytica. It is revealed that about 480 million people are carriers of this disease. Death in the progression of amebiasis in the body occurs in about 100 thousand people. The deterioration of living standards, poor sanitation and the relocation of people lead to the spread of disease. In our country, foci of amoebiasis are located in the southern regions. But in recent years, the number of sick people has increased due to the migration of the southern population to northern latitudes. Also, many residents of our country began to travel to distant exotic countries, which also leads to the spread of amebiasis. Infected people in our country has become more. And we are talking about residents of cities such as Moscow and St. Petersburg. Therefore, amebiasis is a serious medical problem.
In human waste there are such amoebas:
- Entamoeba histolytica. This amoeba can be a source of infection.
- Entamoeba dispar.
- Entamoeba hartmanni.
- Entamoeba coli.
- Endolimax nana.
- Lodamoeba butschlii.
- Blastocystis hominis.
Amebiasis is a lesion of an organism with the simplest microorganisms, amoebas. Infection occurs when cysts enter the upper part of the large intestine. Amoeba, which is the cause of the disease, is called Entamoeba histolytica. Ulcers form in the large intestine, and abscesses in other organs (for example, in the lungs, on the skin or in the liver).
Symptoms and signs
On what grounds can you determine that a person has amebiasis? Symptoms of the disease may not appear immediately. With good body resistance, cysts and luminal forms can stay in the intestine for a long time, without causing disease. But if adverse conditions (hot climate, poor protein-free diet, dysbacteriosis) cysts turn into translucent forms and invade the intestinal tissue (tissue form), which is accompanied by inflammation and ulceration (intestinal form), sometimes even provoke tissue necrosis. Sometimes the incubation period can last several months. But often there are cases when the symptoms of amebiasis appear within a week after infection of the body.
The disease (amebiasis) can be intestinal and extraintestinal. Depending on the type of disease, the symptoms will vary.
Signs of intestinal form
Intestinal type amebiasis, as the name implies, affects the intestines. How can you understand that a person has this particular ailment? According to the following features.
- In the intestinal form of the disease there is a disorder of the chair. No wonder that the second name for pathology is amoebic dysentery. Amebiasis in 10% of cases takes the form of lightning dysentery, which is characterized by profuse diarrhea with patches of mucus and blood in the feces. During the day a person may experience up to 20 urges to empty the bowel.
- Feces look like burgundy jelly.
- At the bottom of the abdomen there are pain sensations, the intensity of which increases after going to the toilet. These pains are cramping in nature.
- Also, a person has abdominal cramps.
- The temperature rises. As a rule, a couple of degrees (no more). Sometimes it can be normal.
- You should know that the human body can infect the appendix - amebic typhlitis. In this situation, the diagnosis of amebiasis is difficult, as the patient shows signs of acute appendicitis. Namely: severe pain in the right side of the body under the rib, high fever, abdominal tone, etc.
- Dehydration of the body.
- General condition of weakness and drowsiness.
Acute amebiasis lasts up to 6 weeks. Next comes remission. This condition is characterized by normal well-being and lasts from several weeks to several months.
Signs that the body is infected with extraintestinal amebiasis
You should know that extraintestinal amebiasis is characterized by the fact that harmful microorganisms infect other human organs.
Depending on the localization of microorganisms, pathology is divided into several types:
- Parasites can affect the outer lining of the heart.
- Amebiasis of the liver. This disease is acute. The body temperature rises sharply (up to 39 degrees and above). A person begins chills and excessive sweating. There are severe pains in the right hypochondrium, which are aggravated during coughing, turning and pressing on the liver area. The skin and whites of the eyes become yellow. You should know that if the abscess is inside the liver, then the above symptoms may be absent or be not so sharp.
- Amoebic pneumonia, or pneumonia. This lung injury is characterized by high body temperature. A person also begins to have chills and pain in the chest area. This condition is accompanied by coughing and shortness of breath. When coughing, sputum is mixed with blood.
- Encephalitis (inflammation of the brain). The symptoms of the disease may be different. They depend on the area of the brain damage. If the cerebellum is affected, the coordination of movements will be disturbed in the person. When inflammation of the brain in the frontal part will be observed convulsions.
- Amebiasis skin lesion. In this case, various ulcers and erosion appear on the human skin. Usually these defects are found on the abdomen, buttocks and perineum. This type of pathology affects people with a weakened immune system.
If a person does not take any measures to treat this disease, it takes on a chronic form and can take several years. Chronic amebiasis is characterized by periods of exacerbation and recession.
There are cases when a person suffers from this disease for decades. If the disease lasts for several years, you can not do without complications. These include the following conditions and pathologies:
- Drowsiness, lethargy, loss of strength and, as a consequence, a decrease in human performance.
- Anemia (anemia). In the human body decreases the number of red blood cells and hemoglobin.
- Loss of body weight, depletion of the body.
- Lack of vitamins.
Forms of amebiasis
Amebiasis can occur in different forms, each of which is accompanied by certain symptoms. They differ in the severity of the patient's condition and the focus of localization of pathogenic microflora. Also important is the human immune system. Amebiasis can occur without any symptoms or with their presence. Unsystematic course of the disease is characterized by the fact that the body does not give any signals that it is infected.
Manifest course of the disease with the presence of symptoms
As a rule, a person's body temperature rises, frequent diarrhea, pain in the abdomen. The manifest course of the disease can be classified into several categories:
- Intestinal amebiasis. The name speaks for itself. That is, the causative agent of amebiasis affects the intestines.
- Extra-intestinal. With this variant of the disease affects other organs of the human body.
- Amebiasis of the skin. The human skin is affected. Usually, people with weakened immune systems are affected. Also, cutaneous amebiasis can be caused by intestinal and is its complication.
Acute and chronic forms of pathology: signs
By the way the disease proceeds, it is divided into acute and chronic amebiasis. In the acute stage, the patient feels very bad. As the disease progresses rapidly. The chronic stage of the disease can be divided into two types. The first type is characterized by a continuous flow, and the second - renewable. In the second form, the patient has periods of remission, when the state of the body returns to normal. But after a certain time the illness again takes a sharp form.
As for extraintestinal amebiasis, it is also classified into several types, has varying degrees of severity, depending on which organ is affected by the pathogen. There are such pathologies:
- amebic hepatitis,
- liver abscess,
- amebiasis of the lungs, human brain or skin.
Amoebic dysentery is invasive (with the presence of a certain semantics) and non-invasive, in other words, asymptomatic.
The latter type is characterized by the temporary presence of microorganisms in the body in an unfavorable environment. For non-invasive amebiasis, the following symptoms are characteristic:
- The absence of any symptoms indicating the presence of microorganisms in the body.
- Does not show any pathology endoscopy.
- Microorganisms are in an inactive phase. Therefore, this condition is characterized by signs such as the absence of hematophagous trophozoites.
- The absence of antibodies in the human blood, which could show in the study that the body is struggling with any foreign trace elements.
Causes of the disease
How does a person become infected with this disease? The causative agent of amebiasis is the simplest amoeba called Entamoeba histolytica. She may be at rest and not pose any danger. But it can also be in a vegetative form of development. When released into the external environment, Entamoeba histolytica is at rest, which protects it from the effects of the external environment and various adverse factors. The vegetative form of the amoeba has its name - trophositol. It develops from cysts. If trophozoite is formed outside the body, then it dies. The source of infection is an unhealthy person. When emptying, it releases infected feces. Next, another infection may occur. Infected cysts are excreted from feces. They can get into the water or soil. Also, sources of infection may accidentally become vegetables or fruits. In general, those products that have not been subjected to any processing. Therefore, before eating any vegetables from the garden, remember that there is a possibility that they may be infected with cysts. In this regard, you should follow all the rules for processing products. There are a great many ways to transmit this disease (even sexually through anal sex). You can also get through food, household items, and more.
What is the danger?
The danger of this disease lies in the fact that in the intestine amoebae begin to multiply. After which numerous abscesses are formed. They also pass into the rectum, where they continue to parasitize. A large accumulation of amoebas can lead to rupture of the intestinal walls. They can also spread to other organs of the human body.
How is the diagnosis? Possible survey options
We have already figured out what is amebiasis, the symptoms described. Now the time has come to talk about the diagnosis of the disease.
It should be said that in case of any disruption of the body's operation, it is recommended to contact the doctor as soon as possible for examination and an accurate diagnosis.
- Any visit to the doctor begins with a survey of the patient and recognition of his complaints. Therefore, before going to the doctor, you must observe yourself and identify the symptoms present. To diagnose amoebiasis, the doctor will ask if the body temperature has risen or if there is diarrhea. How often a person has an emptying, whether there are blood patches in them. It is also necessary to find out if a person has traveled abroad lately. Namely, in countries with a low standard of living and located in a tropical or subtropical climate. This is an important point, since the foci of a high level of amoebiasis are located in such countries.
- After interviewing the patient, the doctor conducts an examination. Namely carries out a palpation of a stomach. Asks if pain is present. The doctor also examines the skin of a person for any erosions and ulcers.
- Next is assigned to the analysis. First of all, this blood test. As a rule, the eosinophil level rises when the human body is infected with amoebae. This indicator suggests that the body fights with any parasites. In addition, anemia develops when a person is infected with amoebiasis. The number of red bodies decreases. A biochemical blood test is also prescribed. It allows you to determine the amount of protein and other trace elements that can confirm or deny the presence of the simplest in the human body.
- Analysis of feces. This study may indicate the presence of live amoebas. Therefore, it should be given to the laboratory feces for analysis immediately immediately after emptying.
- Examination of the intestine with an endoscope. It allows you to identify the presence of ulcers in the intestines and various defects. Also, this device allows you to make a sampling of the intestinal mucosa and immediately send it to the laboratory for further research.
- Also, the doctor prescribes immunological diagnosis. It allows you to determine whether there is protein in the body. If there is, then the probability of the presence of amoebas increases.
- Molecular diagnosis of the disease. The study of other human organs in the presence in the body of extraintestinal amebiasis. Survey data is done by ultrasound, x-ray and MRI.
- Consultation of the gastroenterologist.
There are two treatment options for this disease: conservative and surgical.
How to treat a conservative method amebiasis? Drugs used for this therapy:
- Antiprotozoal drugs.
- Multivitamins, drugs to combat dehydration, painkillers and hepatoprotectors.
Preventive measures for the prevention of amebiasis
In order to prevent this disease, it is first necessary to abandon the use of raw water. Since it may be infected. Only foods that have been heat treated should be eaten. After treatment, it is recommended to be under the supervision of a physician for at least a year.
When planning a trip to countries with a tropical or subtropical climate, you should consult with your doctor and find out what prevention measures should be taken in these countries. Vaccination is also possible. It should be remembered that the grafting of the body is carried out in advance, and not immediately before the trip. Particularly high risk of infection in countries with low living standards.
Now you know how to diagnose amoebiasis, what is the disease. Symptoms and causes of its occurrence, we also examined in detail. Methods for treating this disease are also described in the article. Although any disease is much easier to prevent than to cure. After all, any therapy requires a lot of money and time. Therefore, our article examined preventive measures that will help you protect yourself and your family from such a serious and dangerous disease as amebiasis. Be healthy!
The causative agent - the simplest amoeba
Amoebiasis causes the simplest microorganism - amoeba. She goes through 2 stages of the life cycle - the vegetative stage and the cysts stage (at this time the amoeba is at rest).
During the vegetative stage, the amoeba can take various forms:
Tissue form. Such amoebas are very mobile and can penetrate into various environments. During this period, they lead to acute inflammation of the internal organs of their carrier.
Large vegetative form. Such amoebas have the ability to absorb red blood cells.
Luminous form. Amoebas lose mobility. In such a form, microorganisms exist in the intestine during a person’s recovery.
In the cysts stage, the amoeba can be represented by two forms:
Predtsistnayathe form. Amoeba has a low mobility. In this form, it exists outside the human body. The microorganism retains its activity for several months, if there are favorable conditions for this.
Cyst. Such an amoeba can exist outside the human body for several months. She lives in the soil for 7 days. Amoeba is not afraid of the cold, it retains its activity at -20 degrees. The microorganism dies during drying.
Unlike cysts, the vegetative forms of amoeba are not stable in the external environment. If the disease has an acute course, luminal and tissue forms of amoebas will be present in the stool of the patient. When a person begins to recover, cysts, translucent and predtsistny forms are sown in the feces.
A cyst is able to maintain its vital activity outside the human body for a long time. It is represented by a spherical quad vacuole, which is surrounded by a colorless envelope. After penetration of cysts into the small intestine, a mature amoeba emerges from it, which begins to divide. Each mature amoeba gives 8 new amoebas with one core. All young amoebas have the ability to reproduce. In the large intestine, they fall into a vegetative form.
Ways of infection
Amebiasis distributor is a sick person. It releases into the environment various types of amoebas and cysts. Moreover, an infected person is infectious after the end of the acute phase of the disease. He can distinguish amoebas for several years. The average number of amoebas that come out of a sick person per day is 9000 million. During the acute phase of amebiasis, a person is not infectious, as he releases vegetative forms of amoebae to the external environment.
People become infected when cysts enter the body. Adding occurs when eating unwashed foods, or with poor hygiene (illness of dirty hands). In terms of infection the danger is unwashed dishes, things, bedding. Carriers of infection may be cockroaches and flies.
Most often men aged 20-50 suffer from amebiasis. After infection, immunity is not developed. Amebiasis is widespread in countries with a humid and hot climate, although infection occurs throughout the world.
Once in the intestine, the cyst is transformed into a vegetative form and is invaded into the intestinal wall. In it, it begins to produce substances that destroy organ tissue and lead to the formation of ulcerative defects. They appear from sites of erosion and abscesses, which are represented by nodules. When the nodule is destroyed, vegetative forms of amoebas come out of it, and an ulcer appears in its place. In diameter, each site of ulceration can reach 25 mm.
Ulcers have the ability to merge. The more of them, the higher the probability of damage to the muscular layer of the intestine with its further perforation. This situation is life threatening, as it leads to the development of peritonitis.
Damage to the vascular walls leads to bleeding of varying intensity. When the intestinal walls begin to heal, it can provoke a narrowing of the lumen of the organ and its obstruction.
If amoebas penetrate the bloodstream, they are able to spread throughout the body, penetrate the liver, lungs, brain. If the disease is chronitized, then a tumor ameba is likely to grow in the intestinal lumen. It will be represented by granulation tissue and the body's own cells.
Intestinal form of the disease
Most often it is the intestinal form of the disease. The prodromal period after amoebas enter the body until the first symptoms of the disease appear can last from 7 days to 3 months
The severity of symptoms of the disease depends on the severity of its course. They grow gradually.
Patients appear the following signs of infection:
Abdominal pain that will not be too intense. To a greater extent, a person indicates a feeling of distention of the intestines.
The main symptom of the intestinal form of the disease is diarrhea. It is abundant, it happens up to 10-30 times a day. Stool contains mucus. As the disease progresses, diarrhea increases. Fecal masses lose their shape, become liquid. In addition to mucus, blood appears in the feces. The appearance of the chair resembles raspberry jelly.
Abdominal pains are aggravated, occur according to the type of contractions. Acute symptoms may persist for 7 days. After that comes relief. The disease goes into remission. However, in a few weeks or even months, its aggravation may occur. Such symptoms are characterized by recurrent intestinal amebiasis.
Sometimes the disease has a continuous course. From time to time the symptoms fade away, after which they gain strength again. If a person does not receive treatment, then amebiasis may disturb him for many years (up to 10 or more).
The chronic form of the infection leads to asthenic syndrome, proteins leave the human body, vitamins are washed out. Tongue is covered with a dense raid, appetite disappears. The skin becomes dry, the facial features are sharpened. On palpation of the abdomen a person is in pain.
Intestinal amebiasis should be treated. If therapy is absent, it threatens with the development of severe complications. The heart suffers, the patient develops bradycardia and arrhythmia. Myocardium loses nutrients.
The nervous system with long-term amoebiasis is depleted. A person falls into depression or apathy, he has frequent mood changes, irritability increases.
If the disease is severe, it can lead to complications such as:
Rupture of the intestinal wall.
Pericolitis. Danger is pericolitis, which develops in approximately 10% of patients. Symptoms of the disease resemble peritonitis. Intestinal walls stick together with each other due to fibrin plaque. Spikes and ulcers form on them.
Purulent peritonitis. Joining the purulent process is accompanied by increased pain, fever of the body to feverish marks, vomiting, abdominal distension, and a significant deterioration in health.
Tumor neoplasm in the intestine (amoeboma). It grows in the cecum and in the ascending part of the large intestine. Amoeba often leads to the development of intestinal obstruction.
Intestinal polyps. In amoebiasis, adenomatous neoplasms are often formed in the intestine.
Prolapse of the rectum.
Amoebic appendicitis. This pathology is severe and in 90% of cases is fatal. Complication develops during the acute course of the disease.
If amoebas get into the liver, they can provoke the development of hepatitis or an organ tissue abscess. The person suffers from intense pain, which will be concentrated in the right hypochondrium.
Amoebic liver abscesses are complicated by purulent forms of peritonitis, pleurisy, pericarditis. Mortality among patients exceeds 25%.
The doctor during palpation of the liver notes its increase in size, increased density, pain. Sometimes a person turns yellow skin and mucous membranes. Body temperature can reach high elevations.
Pain can irradiate to the shoulder joint, with a deep breath, they become more intense. To provoke an attack can change the position of the body.
Temperature increase can not be called persistent. It may change during the day. The man looks exhausted, his skin is dry, loses its former elasticity. Eyes sink, cheekbones protrude. In general, the patient looks painful.
Often there is swelling of the lower extremities. Abdomen enlarged. If the disease becomes chronic, depletion will only increase. Liver abscess can be single or multiple. Hepatic amebiasis is a serious illness that often leads to death. If an abscess breaks through, the abnormal masses enter the abdominal cavity, which leads to a peritonitis clinic. Purulent masses are able to enter the pleura and lead to the development of pneumonia, or an abscess of the lungs. Such inflammation often acquires a long course.
Other forms of amebiasis
Together with the bloodstream, amoebas are able to spread throughout the body. Sometimes they reach the brain, leading to symptoms of a lesion. The patient suffers from severe pain, he has convulsions, his sensitivity deteriorates, and paralysis or paresis of the limbs may occur.
Also, amoebas are able to penetrate the spleen, kidneys, and female genitalia. In these organs, they multiply, which leads to the formation of abscesses in them. Symptoms will be associated with the deterioration of the functioning of a specific system of the human body.
Amebiasis treatment regimens
Treatment of the intestinal form of the disease is carried out according to the following schemes:
Metronidazole inside 3 times a day for 8-10 days. Calculate the dose of 30 mg / kg / day.
Tinidazole. Children under 12 years old should be prescribed 50 mg / kg / day, but not more than 2 g per dose. Patients older than 12 years 2 g / day in 1 reception. The course of treatment lasts 3 days.
Ornidazole. Children up to 12 years old are prescribed 40 mg / kg / day, but not more than 2 g in 2 doses. Patients over 12 years old are prescribed 2 g / day in 2 doses. The course of treatment is 3 days.
Secnidazole. Children up to 12 years old are prescribed 30 mg / kg / day in 1 dose. Patients older than 12 years are prescribed 2 g per day once. The course of treatment is 3 days.
If a patient is diagnosed with amebic abscess, the treatment regimen will be as follows:
Metronidazole - 30 mg / kg / day in 3 doses. The course of treatment is 8-10 days.
Tinidazole. Children up to 12 years old are prescribed 50 mg / kg once a day. Patients over 12 years old are prescribed 2 g per day once. The course of treatment lasts 5-10 days.
Ornidazole. Children up to 12 years old are prescribed 40 mg / kg / day, but not more than 2 g in 2 doses. Patients over 12 years old are prescribed 2 g / day in 2 doses. The course of treatment is 5-10 days.
Secnidazole. Children up to 12 years old are prescribed 30 mg / kg / day in 1 dose. Patients older than 12 years are prescribed 2 g per day once. The course of treatment is 3 days.
An alternative treatment regimen for amebic abscess is performed using dehydroemetin dihydrochloride. Patients are given 1 mg / kg / day intramuscularly, but not more than 60 mg. The course of treatment is 4-6 days. After completion of therapy with this drug, patients with liver damage are prescribed Chloroquine 600 mg per day for 2 days, after which the dose is reduced to 300 mg per day and taken for another 14-21 days.
In order to completely destroy the protozoa that could remain in the intestinal lumen, after the completion of the chosen treatment regimen, patients are receiving luminal amebocides. This may be Etofamid (take it for 20 mg / kg / day for 2 weeks) or Paromomycin (take it 5-10 days for 1000 mg / day for 2 doses).