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Entameba
histolytica
is
an
invasive
entric
E.dispar,
E.
moshkovkii,
E.
bangaladesi
are
cause
disease
ranging
from
Dysentry
to
Motile
ORGANISM
Species of Entamoeba
Many Entanoeba species infect humans, but only E.
histolytica is a cause of invasive amebiasis, whereas
E.moshkovskii is associated with a noninvasive diarrhoea
E. histolytica and E. dispar genome share 90% indentity
in genic regions and E.moshkovskii is closely genetically
related.
In most industrialized countries, E. dispar is 10 times
more common than E. histolytica, but equally prevalent
in develpoing countries
Genotypes of E. histolytica
In addition to genetic differences
between the three morphologically
identical amebae E. histolytica, E.
dispar, E. moshkovskii; genetically
different strains exist with E. histolytica.
Certain genotypes are associated with
diarrhoea, others with colonization and
others with amebic liver abcess
fromation.
Life cycle
on pathologic
Clinical manifestations
Asymptomatic Intraluminal Amebiasis
All E. moshkovskii and E. dispar infections and upto 80% of E.
histolytica infections are asymptomatic
Asymptomatic individuals represents a risk to the community
because they are the source of new infection
Asymptomatic infection with E. histolytica also carries a small but
definite risk to the carrier for the subsequent development of
invasive amobiasis
In a study, individuals colonized with E. histolytica, 10% develpoed
invasive disease within 1 year
Amebic Diarrhea
Amebic diarrhea without dysentry is the
most common disease manifestation of
infection with E. histolytica.
Amebic diarrhea is defined as diarrhea in
an E. histolytica infected individuals (for
diagnosis of amoebic diarrhoe, mucus
need not be visible and microscopic
blood need not be present in the stool.
Diagnostic tests
Demonstration of E.histolytica or cyst in the
stool or colonic mucosa of pts with diarrhea
Antigen detection based ELISAs that can
specifically identify E.histolytica in the stool
probably represent the best choice in the
endemic areast
PCR assay for DNA in the stool samples is
currently the most sensitive and specific
method for identification but used as
research and epidemiological tool
Metastatic Amebiasis
Extra-abdominal amebiasis presumably follows direct extension from liver
abscesses rather than direct dissemination from the intestine.
Thoracic amebiasis is the most common type of extra-abdominal
amebiasis and occurs in about 10% of patients with amebic liver abscess.
Symptoms depend on the type of involvement. Empyema,
bronchohepatic fistulas, or extension of a pleuropulmonary abscess into
the pericardium may occur.
Pericardial involvement is the next most common form of extraintestinal
amebiasis and may result from rupture of a liver abscess in the left lobe
of the liver into the pericardium or through extension of the right-sided
pleural amebiasis. It is estimated to occur in 3% of patients with hepatic
abscesses. It manifests as acute pericarditis with tamponade and, on
occasion, as pneumopericardium.
Investigations
1. StoolOvaandParasiteExamination
2. Culture Culture of E. histolytica from stool
samples is more sensitive than stool O&P
examination but significantly less sensitive than
antigen detection or PCR. It is also not specific
for E. histolytica, and thus an E. histolytica
specific antigen detection or PCR test must be
used on the cultured material
3. ColonoscopyandBiopsy
4. PolymeraseChainReactionTesting
forAmebiasis
5. AntigenTestingforAmebiasis The only
fecal antigen test that distinguishes E.
histolytica from E. dispar and E. moshkovskii is
the TechLab E. histolytica II enzyme-linked
immunosorbent assay (ELISA).
6. SerologicTestsforAmebiasis
Treatment
The nitroimidazole compounds are the drug of
choice
To date E.histolytica has not demonstrated
resistance to any of the compound metronidazole
and tinidazole
Tinidazole appears to be better tolerated
Whenever possible fulminant amebic
should be managed conservatively
colitis
Treatment
Neither metronidazole nor tinidazole reaches
high levels in the gut lumen therefore, patients
with amebic colitis or ALA should also receive
treatment with luminal agents (Paramomycin or
iodoquinol) to ensure eradication of infection
Paramomycin is preferred agent
Nitazoxanide, abroad spectrum antiparasitic
drug,is
efficacious
against
E.histolytica
trophozoitesin the both tissue and gut
Drug
Dosage
Side effect
2gPO
oncedaily
5 days
Metronidazol 750mgPO
e
tid10
days
PrimarilyGIsideeffectsand
disulfiram-likeintolerance
reaction toalcoholicbeverages
for5days
anorexia, nausea,vomiting,
diarrhea, abdominaldiscomfort,
or unpleasantmetallictaste;
disulfiram-likeintolerance
reactiontoalcoholicbeverages;
neurotoxicity,includingseizures,
peripheralneuropathy,dizziness,
confusion,irritability
Dose
Side effect
Paromomycin
30mg/kg/dayPO
in threedivided
doses perday
5-10days
PrimarilyGIside
effects:diarrhea,
GI upset
Diloxanide furoate
500mgPOtid
10 days
PrimarilyGIside
effects:flatulence,
nausea,vomiting
Pruritus,urticaria
Drug
Amebic Colitis
Tinidazole
Dose
Side Effect
2gPOonce
daily5 days
Sameasfor
amebicliver
abscess
+
luminalagent
(sameasfor
amebicliver
abscess)
Asymptomatic
Intestinal
Colonization
Treatmentwith
luminalagentas
foramebicliver
absces
Treatment
Aspiration of liver abscess reserved for
the indivisual in whom pyogenic abscess
a bacterial superinfection is suspected but
diagnosis is uncertain,
for pts failing to respond to tinidazole or
metronidazole ( those who have fever or
abdominal pain after 4 days of treatment),
for indivisuals with large liver abscesses in
the left lobe
large abscsee with risk of rupture
Treatment
In contrast, aspiration and percutaneous
catheter
drainage
improves
outcome
in
pleuropulmonary amebiasis and empyema
Percutneous drainage or surgical drainage is
absolutely indicated in amebic pericarditis
Rupture of an amebic liver abscess in
peritoneum is managed conservatively with
medical therapy and percutaneous catheter
drainage
Prevention
Avoidance of ingestion of food and
water contaminated with humen
feces is the only way of prevention
No prophylaxis
No vaccine
GIARDIASIS
INTRODUCTION
Giardia lamblia, a flagellated enteric
protozoan, is a common cause
of sporadic, endemic, and epidemic
diarrhea throughout the world.
It is seen in waterborne outbreaks of
diarrhea, in children who live
in low-income countries, and occasionally
in foodborne outbreaks.
It is a intestinal single-celled parasite .
MORPHOLOGY
Two stages:
1. Trophozoite
2. cyst
Trophozoite
SHAPE
Pear shaped,
Tennis racked shape or heart
shape(when viewed flat).
Size
Length: 10-20um
Width:
5-15um
Thickness:2-4um
Body
Bilaterally symmetrical having a peared structure.
Axostyles
Two in numbers, seen in midline as vertical lines.
Nuclei
Two or one on each side of body.
Flagella
4 pairs helping in moving.
Sucking discs
Circular in shape
Situated on ventral surfaces
CYST
Shape
Oval or ellipsoid
Size
Length: 12um
Width: 8um
Nuclei
Two nuclei in immature cyst
Four nuclei in mature cyst.
Flagella &sucking discs
may be seen in cytoplasm.
Multiplied by
binary fission
Trophozoites
Outside
Diarrhea
Mature Cysts
Stool
Trophozoites
Cysts
Outside
Pathogenes
G. lamblia
isinhabits in the duodenum and upper ileum
Trophozoites are attached to the mucosa
surface by sucker, reproduced by binary fission
Histology: shortening of microvilli, elongation of crypts,
and damaging the brush border of the absorptive cells
Symptoms
Symptoms of giardiasis normally begin 1 to 2 weeks
(average 7
days) after becoming infected
Diarrhea
Malaise
Flatulence
Foul-smelling, greasy stools
Abdominal cramps
Bloating
Nausea
Anorexia
Weight loss
Vomiting
Fever
Urticaria
Constipation
Possible Complications
Dehydration
Malabsorption
Weight loss
Diagnosis
The diagnosis of giardiasis should be
considered in all patients with
prolonged diarrhea, particularly that
which is associated with
malabsorption or weight loss.
O&P examination
The stool should be examined fresh and after
preservation.
A saline wet mount of fresh liquid stool obtained in the
acute stages of illness may yield motile trophozoites.
In semiformed stool, trophozoites are usually not
found.
Giardia should be identified 60% to 80% of the time
after one stool, and some report over 90%
identification after three stools.
Antigen assays
Antigen assays are most helpful when giardiasis is the
leading consideration, such as during an outbreak,
when screening children in daycare, or when testing
patients for cure after the completion of treatment.
They are often less expensive than an O&P examination
85% to 98% sensitive and 90% to 100% specific
PCR is highly sensitive, has the capacity to detect as
few as one or two cysts per sample, and can identify
the assemblage
TreatmentofGiardiasis
DRUG
Tinidazole
Metronidazole
Nitazoxanide
Albendazole
Paromomycin
Quinacrine
Furazolidone
DOSE
2 g, single dose
250 mg tid 5-7
days
500 mg bid 3 days
400 mg qd 5 days
500 mg tid 5-10
days
100 mg tid 5-7
days
100 mg qid 7-10
Prevention
Avoid water that might be contaminated.
Avoid food that might be contaminated.
Boil water before drinking.
Do not brush teeth with tap water that may be
contaminated.
Do not use ice or drink beverages made from tap water
that may be contaminated.
Wash hands before eating food etc.
THANK YOU