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Amoebiasis Clinical Case 10. Ellen Marie de los Reyes. EF, a fresh college graduate, is applying for a job at a pharmaceutical company. Routine laboratory examinations were requested. Fecalysis revealed (+) E histolytica cyst. Patient is asymptomatic. 1. Give your Diagnosis. Amoebiasis.

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amoebiasis clinical case 10

AmoebiasisClinical Case 10

Ellen Marie de los Reyes

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EF, a fresh college graduate, is applying for a job at a pharmaceutical company. Routine laboratory examinations were requested. Fecalysis revealed (+) E histolytica cyst. Patient is asymptomatic.
amoebiasis
Amoebiasis
  • An infection with Entamoeba histolytica produced by the ingestion of cysts in the organism
  • In the intestines, the cysts develop into trophozoites that adhere to colonic epithelial cells by means of a lectin on the parasite
amoebiasis5
Amoebiasis
  • Lyses the host cell
  • invades the submucosa and secretes IFN-γactivated macrophages
  • This will result in dysentery
  • The parasite can invade the liver and can develop liver abscesses and an amoebic granulomas developing in the intestinal wall
symptoms
Symptoms
  • gastrointestinal including diarrhoea, vomiting, abdominal pain or discomfort and fever.
  • Duration: few days to a few weeks but usually it is about two to four weeks.
  • Most are asymptomatic
  • has the potential to make the sufferer dangerously ill
  • Infections that sometimes last for years may be accompanied by
    • no symptoms (in the majority of cases),
    • vague gastrointestinal distress,
    • dysentery (with blood and mucus).
asymptomatic infection
Asymptomatic Infection
  • the amoeba lives by eating and digesting bacteria and food particles in the gut.
  • It does not usually come in contact with the intestine itself due to the protective layer of mucus that lines the gut.
  • Disease occurs when amoeba comes in contact with the cells lining the intestine.
  • secretes toxic substances, including enzymes that destroy cell membranes and allow it to penetrate and digest human tissues, resulting in flask-shaped ulcers in the intestine.
amoebiasis8
Amoebiasis
  • Amoebiasis is transmitted:
    • fecal contamination of drinking water foods
    • direct contact with dirty hands
    • sexual contact
main drugs
Main drugs
  • Metronidazole
  • Tinidazole
  • Diloxanide

*These agents may be used in combination

drugs of choice for various forms of amoeboisis
Drugs of choice for various forms of Amoeboisis
  • Acute invasive intestinal amoeboisis resulting in acute severe amoebic dysentary> metronidazole followed by diloxanide
  • Chronic intestinal amoeboisis>diloxanide
  • Heptic amoeboisis>metronidazole followed by dilxanide
  • Carrier state>diloxanide
metronidazole
Metronidazole
  • Kills the trophozoites of E. histolytica by damaging the DNA by toxic oxygen products generated by thedrug
  • But has no effect on the cysts
  • Most effective drug available for invasive amoebiasis
pharmacokinetics
Pharmacokinetics
  • Usually given orally
  • Rapidly, completely absorbed
  • Peak plasma concentration 1-3 hrs
  • Half-life 7 hrs
  • Distributed rapidly through the tissues reaching high concentrations in the body fluids and CSF
  • Some are metabolized and most excreted in urine
unwanted effects
Unwanted effects
  • Bitter taste in the mouth
  • Minor gastrointestinal disturbances
  • Dizziness, headache, sensory neuropathies
  • Drug interferes with alcohol metabolism
tinidazole
Tinidazole
  • Similar to metronidazole
  • Eliminated more slowly
  • Half-life 12-14 hrs
diloxanide
Diloxanide
  • Effective against the non-invasive intestinal parasite
  • Drugs have a direct amoebicidal action affecting the amoebae before encystment
  • Given orally
  • No serious adverse effects