Amebiasis

o Fever
o Weight loss
o Abdominal pain, distension, and rebound tenderness likely in fulminant colitis

Causes

Amebiasis is an infection caused by the protozoal organism E histolytica, which can cause colitis and
other extraintestinal manifestations, including liver abscess (most common) and pleuropulmonary,
cardiac, and cerebral dissemination.

E histolytica is transmitted primarily through the fecal-oral route. Infective cysts can be found in
fecally contaminated food and water supplies and contaminated hands of food handlers. Sexual
transmission is possible, especially in the setting of oral-anal practices.

Ascariasis

Clinical

History

• Early symptoms of ascariasis, during the initial lung migration, include cough, dyspnea,
wheezing, and chest pain.
• Abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea may be
manifestations of partial or complete intestinal obstruction by adult worms.
• Jaundice, nausea, vomiting, fever, and severe or radiating abdominal pain may suggest
cholangitis, pancreatitis, or appendicitis.

Physical

• Rales, wheezes, and tachypnea may develop during pulmonary migration, particularly in
persons with a high worm burden. Urticaria and fever may also develop late in the migratory
phase.
• Abdominal distension is nonspecific but is common in children with ascariasis.
• Abdominal tenderness, especially in the right upper quadrant, hypogastrium, or right lower
quadrant, may suggest complications of ascariasis.
• Evidence for nutritional deficiency due to ascariasis is strongest for vitamins A and C, as well
as for protein, as indicated by albumin and growth studies in children observed prospectively.
Some studies have not confirmed nutritional or developmental delay due to ascariasis.

Anemia defisiensi besi

Strongyloides =S stercoralis

Strongyloides is a helminthic pathogen associated with infection that is clinically characterized by

watery diarrhea, abdominal cramping, and urticarial rash. Although hookworm eggs are easily
distinguished from the eggs of other helminth, rhabditiform larvae are occasionally seen in old stool
specimens. Differentiating hookworm larvae from those of Strongyloides organisms requires attention
to the unique morphologic features, particularly the relatively short buccal cavity and prominent
genital primordium of Strongyloides larvae.
Gastroenteritis

 Bacterial infections cause most gastroenteritis cases in less affluent nations.

• The most important causal agent in these countries is diarrhea-causing E coli (eg,
enteropathogenic [EPEC], enterotoxigenic [ETEC], enteroaggregative [EAEC],
enteroinvasive [EIEC], enterohemorrhagic [EHEC]).
• Other bacteria that cause gastroenteritis less often include Campylobacter, Aeromonas,
Shigella, and Salmonella species.
• Vibrios species, especially Vibrios cholerae, play major roles in epidemics. In seafood
poisoning, Vibrio parahaemolyticus is associated with gastroenteritis.

 Viral infections cause 30-40% of gastroenteritis cases in affluent countries.

• Rotavirus is the single most important cause of dehydrating diarrhea in both developed and
developing countries. It produces severe diarrhea, accounting for most episodes in children
younger than 2 years who require hospitalization for diarrhea and dehydration.1
• Norwalk virus is responsible for outbreaks of gastroenteritis in older children and adults.
Unlike rotavirus, which affects mainly children, the Norwalk virus causes illness in all age
groups.
• Enteric adenoviruses account for 5-20% of hospitalizations for acute diarrhea. Compared to
rotavirus and Norwalk virus, enteric adenoviruses have a longer incubation period (ie, 8-10 d
compared with 1-3 d), and the diarrhea associated with adenoviruses lasts longer (ie, 5-12 d
compared with 5-7 d for rotavirus and 1-2 d for Norwalk). Astroviruses and caliciviruses each
account for 3-5% hospitalizations for acute diarrhea.

Under basic light microscopy, the eggs of N americanus and A duodenale appear morphologically
similar. During clinical evaluation, this distinction is not necessary because the management remains
the same for both.

Epidemiology

The absolute number of hookworm infections is highest in China with 203 million followed
by sub-Saharan Africa with 198 million.1 When prevalences are compared, sub-Saharan
Africa is highest with 29% of the population infected followed by East Asia, which has a
prevalence of 26%. India, South Asia, and Latin America have slightly decreased but still
notable infection rates.

Mortality/Morbidity
The mortality rate is low and likely under recognized because of its insidious nature. Anemia
remains the most significant clinical implication of hookworm disease. Because of chronic
reinfection, hypoproteinemia, weight loss, oedema, and anasarca may also occur. See Special
Concerns.

Age
Although children bear a large disease burden, hookworm infection appears to have an
atypical distribution of infection by age. Unlike other soil-transmitted helminth infections,
such as those due to Ascaris or Trichuris organisms (for which the incidence peaks in
childhood), hookworm infection appears to continue to increase throughout childhood until it
reaches a plateau in adulthood.
Clinical

History

* Most individuals with hookworm infection are asymptomatic.

* During the first 1-2 weeks after a cutaneous infection, hookworm produces an intensely
pruritic dermatitis at the site of infection termed ground itch.

* Wakana syndrome occurs in people who have been infected with a large burden of A
duodenale by means of oral ingestion. This syndrome is similar to an immediate-type
hypersensitivity reaction characterized by pharyngeal itching, hoarseness, nausea, vomiting,
cough, dyspnea, and eosinophilia.7

* Mild cough, dysphagia, and fever may occur during pulmonary migration.

* Loeffler syndrome is rare during pulmonary infection. It is characterized by paroxysmal

attacks of cough, dyspnea, pleurisy, little or no fever, and eosinophilic pulmonary infiltrates
that last several weeks after the initial infection.7

* After the worm migrates into the intestines, patients may have nausea, abdominal pain, and
flatulence. These symptoms peak 30-45 days after infection.

* Patients with severe anemia may have fatigue, syncope, or exertional dyspnea. They may
also have a history of perverted taste and pica.

Physical

* Stunted growth may be observed in children with severe infection.

* An erythematous, pruritic, papulovesicular rash on the palms and soles at the site of initial
infection may persist for 1-2 weeks after initial infection.

* During pulmonary migration, cough, fever, and a reactive bronchoconstriction may be

observed, with wheezing heard on auscultation.

* Abdominal examination may reveal midepigastric pain on palpation during the period of
intestinal involvement.

* Hypoproteinemia may lead to anasarca and peripheral edema.4

* Tachycardia, hypothermia, and pallor may be present due to anemia.

* Stools may be bloody or melanotic.