Amoebiasis diseases , symptoms of amoebiasis , diagnosis and prevention

 6. AMOEBIASIS

Amoebiasis is an infection caused by the protozoan Entamoeba histolytica that is usually contracted by drinking contaminated water or eating amoebic cyst-contaminated food. The majority of infected people are asymptomatic, but the disease has the potential to be chronic, and the WHO estimates that approximately 70,000 people die each year worldwide.

Symptoms range from mild diarrhea to dysentery with blood and mucus and can appear within 2-4 weeks of infection and can last for years. The blood is derived from the intestine's damaged lining. Amoebae enter the bloodstream in about 10% of invasive cases and may travel to other organs in the body, such as the liver, where blood from the intestine arrives first, but they can end up almost anywhere.

Because the amoeba does not come into contact with the intestine due to the protective mucus layer lining the gut, it survives by eating and digesting bacteria and food particles in the gut during asymptomatic infections. When an amoeba comes into contact with the intestinal lining, it secretes enzymes that destroy cell membranes and proteins, resulting in flask-shaped ulcers. Entamoeba histolytica phagocytoses the destroyed cells and is frequently seen with red blood cells inside. A granulomatous mass known as an amoeboma can form in the colon wall as a result of a persistent cellular response, which can be mistaken for cancer.

Symptoms of Amoebiasis

Amoebiasis is characterized by gastroenteritis, diarrhea, or dysentery, as well as abdominal pain and exhaustion. Poor appetite or fear of food can occur as a result of abdominal bloating, cramps, and loose stools. Later, as the infection worsens, fever, nausea, and bloody stools with slimy mucous appear, complicating the situation. The patient eventually loses weight and stamina. Because of the release of toxic substances or dead parasites inside the intestines, allergic reactions can occur throughout the body at times. Dehydration, gas formation, and foul-smelling stools are common, and diarrhea appears and disappears. The stool contains mucus and blood.

Diagnosis

Asymptomatic human infections are typically diagnosed by the presence of cysts in the stool. To recover the cysts from faecal matter, various flotation or sedimentation procedures have been developed, and stains aid in the visualisation of the isolated cysts for microscopic examination. Because cysts are not constantly shed, a minimum of three stools should be examined. The motile form (the trophozoite) is frequently seen in fresh feces in symptomatic infections.

Serological tests are available, and most people (symptomatic or not) will test positive for the presence of antibodies. Individuals with liver abscesses have much higher antibody levels. Serology becomes positive approximately two weeks after infection. A kit that detects the presence of ameba proteins in feces and another that detects ameba DNA in feces are recent developments. Due to the high cost of these tests, they are not widely used.

Colon biopsy is still the most common method of diagnosing amoebic dysentery around the world. However, it is not as sensitive or accurate as other diagnostic tests. The appearance of the E. histolytica cyst distinguishes it from cysts of nonpathogenic intestinal protozoa such as Entamoeba coli. E. histolytica cysts can have up to four nuclei, whereas commensal Entamoeba coli can have up to eight nuclei.

Furthermore, in E. histolytica, the endosome is centrally located in the nucleus, whereas in Entamoeba coli, it is off-center. Finally, in E.histolytica, chromatoidal bodies are rounded, whereas in Entamoeba coli, they are jagged. Entamoeba dispar and E. moshkovskii, however, are also commensals and cannot be distinguished from E. histolytica under the microscope. Because E. dispar is much more common than E. histolytica in most parts of the world, there is a lot of misdiagnosis of E. histolytica infection. The WHO advises against treating infections diagnosed solely by microscopy if they are asymptomatic and there is no other reason to suspect that the infection is caused by E. histolytica.

Prevention

To aid in the prevention of amoebiasis in the home:

After using the toilet or changing a baby's diaper, and before handling food, thoroughly wash your hands with soap and hot running water for at least 10 seconds.

Clean the bathrooms and toilets on a regular basis. Pay close attention to the toilet seats and faucets.

Towels and face washers should not be shared.

When visiting endemic areas, avoid eating raw vegetables because they may have been fertilised with human feces.

Bring water to a boil or use iodine tablets to treat.

Treatment

Infections with E. histolytica can occur in both the intestine and (in people who have symptoms) in intestine and/or liver tissue. As a result, two different types of drugs, one for each location, are required to rid the body of the infection. Metronidazole and related drugs like tinidazole and ornidazole are used to kill amebae that have infiltrated tissue. It quickly enters the bloodstream and travels to the site of infection. Because it is quickly absorbed, almost none remains in the intestine.

Because most amoebae remain in the intestine after tissue invasion, it is critical to remove them as well, or the patient will be at risk of developing another case of invasive disease. Paromomycin (also known as Humatin) is the most effective antibiotic for treating intestinal infections; Diloxanide furoate is used in the United States. To treat infections, both types of drugs must be used, with metronidazole usually administered first, followed by paromomycin or diloxanide. E. dispar does not require treatment, but many laboratories (even in the developed world) lack the equipment to differentiate it from E. histolytica.

A multi-pronged approach is required for amoebic dysentery, beginning with one of the following:

Metronidazole, 500-750 mg three times per day for five to ten days.

Tinidazole, 2g once daily for 3 days, can be used instead of metronidazole.

500 mg ornidazole twice a day for 5 days.

In addition to the above, one of the luminal amebicides listed below should be prescribed as an adjunctive treatment, either concurrently or sequentially, to eliminate E. histolytica in the colon:

For ten days, take 500mg of paromomycin three times a day.

For 10 days, take 500mg of DiloxanideFuroate three times a day.

For 20 days, take 650mg of iodoquinol three times a day.

The following medications are prescribed for amoebic liver abscesses:

Metronidazole 400mg three times daily for ten days

Tinidazole, 2g once daily for 6 days, can be used instead of metronidazole.

Diloxanidefuroate, 500mg three times a day for ten days, must always be administered following.

Children's doses are calculated based on body weight, and a pharmacist should be consulted for assistance.

DISEASE NO 7.

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